Distribution Of TCM Syndromes And Risk Factors Of Prognosis In Liver Failure

Objective:1.To explore the distribution characteristics of TCM syndromes in patients with liver failure and the related risk factors affecting their short-term prognosis(3months)?Methods:Retrospective analysis of Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine in January 2013-December 2016 hospitalized 107 cases of liver failure in patients with clinical data,combined with four diagnostic data for TCM syndrome differentiation,to explore the impact of short-term prognosis(3 months)(ROC curve)model was used to select the independent risk factors that affected the prognosis.Results:1.During the three months of follow-up,67 of 137 patients with liver failure died,with a mortality rate of 62.6% and an average survival time of(23.60±14.49)days in the death group.69 cases(64.49%)of infection,56 cases(52.34%)of hepatic encephalopathy,33 cases(30.84%)of hepatopulmonary syndrome,21 cases(19.63%)of hepatorenal syndrome,Gastrointestinal bleeding in 17 cases(15.89%);2.The prevalence of damp-heat syndrome was 41 cases(38.30%),followed by 3 cases(29.00%)of stasis syndrome,20 cases(18.70%)of Yangxuyuhuang syndrome,There were no statistically significant differences(P> 0.05)between the survival group and the death group(P<0.05).3.The frequency of TCM syndromes was higher and there was a significant difference between survival group and death group:hemorrhage(epistaxis,hematemesis,blood in the stool,subcutaneous ecchymosis,etc.),dry stool,Belly blue veins revealed,P values were 0.013,0.016,0.009,respectively;4.The difference of TCM syndrome scores between Liver failure survival group and death group was statistically significant(? 2=4.717,P=0.000).The TCM syndrome score is introduced into the ROC model as a covariate,the maximum critical area of AUC 0.748(95% CI 0.657~0.838)was29.5 points,the sensitivity was 64.2%,the specificity was 80%.5.The scores of BUN,Scr,Scr-7,CRP,Cys C,Child score and MELD score in the survival group and the death group were statistically significant(P <0.05).According to the ROC curve,the area under the ROC curve of the clinical outcome of PCT,CRP,BUN,Scr,Scr-7,and MELD was0.697(95% CI 0.587~0.806),0.771(95% CI 0.601~0.942),0.622(95% CI0.519~0.731),0.622(95% CI 0.513~0.731),0.790(95% CI 0.619~0.889),0.617(95% CI0.508~0.726);6.Scr?65.55umol/L,the sensitivity and specificity of predicting short-term clinical outcome in patients with liver failure were 77.6% and 42.5%;Scr-7 ?87.29umol/L,the sensitivity and specificity were 66.7%,83.3%;BUN ? 3.21mmol/L,the sensitivity and specificity were 85.1%,37.5%;CRP?19mg/L,the sensitivity and specificity were 85.7%,45.7%;PCT ? 0.47ng/ml,the sensitivity and specificity were 73.7%,63.2%;MELD?25,the sensitivity and specificity were 66.7%,55%.Conclusion:1.The higher the score,the greater the risk of death,Which bleeding,dry stool,abdominal wall green bars revealed that the impact of short-term prognosis of patients with liver failure independent risk factors.2.Clinical predictors of short-term prognosis in patients with liver failure:PCT?BUN?Scr?Scr-7?CRP?MELD,Which Scr-7and CRP co-predicted with a higher value,indicating that renal damage and infection is the key to short-term prognosis of patients with liver failure.