A Retrospective Study Of Prognosis On Acute-on-chronic Liver Failure

Objective To find the independent risk factors of the prognosis of acute-on-chronic liver failure(ACLF) and establish new prognosis model. To evaluate the predicting value of CTP scoring,MELD scoring system,MELD-Na scoring system and new prognositic model of the ACLF. To study the relationship between the dynamic change of total bilirubin and outcomes after artificial liver treatment. To provide the basis for early clinical intervention and strategy on ACLF.Methods Restrospective analysis was applied in studying the clinical aspects of 108 patients with ACLF hospitalized between January 2012 to November 2015 in Zhongshan Hospital Xiamen University and the fatality rate of the patients within 3 months. Recording the result of blood routine,biochemical and coagulation in 24 hours for each patient, besides, the complications such as hepatic encephalopathy(HE), ascites, gastrointestinal bleeding, infection, hepatorenal syndrome and so on. Multi-factors logistic regression was used to find the independent risk factors of prognosis of ACLF, and establish new prognosis model.The receiver operating characteristic curve(ROC curve) and the area under the curve(AUC) were used to evaluate predicting values of CTP scoring,MELD,MELD-Na scoring system and new prognositic model for ACLF.Z test was used to compare the AUC of each scoring system. The maximum rate and the average rate of TBil were used to analyse the relationship between dynamic changes and outcome of 42 cases who undergo artificial liver treatment with ACLF.Result 1. Hepatitis B virus inflection was the main cause of ACLF. Eighty-two patients was infected by HBV,accounted for 75.93%, and followed by the alcoholic damage. 2.Forty-three patients died within 3 months,the mortality was 39.81%.The age, white blood cells(WBC), prothrombin time(PT), international normalized ratio(INR),TBil, creatinine(Cr),the rate of HE in the death group were significantly higher than that of the survival group(P<0.05),besides,the cholinesterase(CHE) and serum sodium(Na) were significantly lower than survival group(P<0.05). Multi-factors logistic regression analysis showed that INR, PT, TBil, Na, HE are the independent prognostic risk factors of ACLF.3.Drawing ROC curve for each score,besides new prognositic model,showed that CTP score AUC < MELDAUC < MELD- NaAUC < new modelAUC. The predicting ability of new model is the best with the biggest AUC,and the rest of the scoring system have similar predicting values(P>0.05). 4.Among 42 patients who undergo artificial liver treatment, the CTP, MELD, MELD-Na scoring systems and the new prognositic model have significantly difference between the death and the survival groups(P<0.05).The maximum rate and the average rate of TBil in the death have significantly difference compared with the survival group(P<0.05).Conclusion 1.HBV inflection is the major cause of ACLF,followed by alcoholic damage. 2.INR,PT,TBil,Na,HE are the independent prognostic risk factors of ACLF. 3.All of the scoring systems,besides the new prognositic model have the predictive value to ACLF,while regression model is superior than others and it can complement each other with other score. 4.The maximum rate and the average rate of TBil can be taken as a basis for evaluating the effect of artificial liver treatment.