| ObjectiveHepatitis B virus related acute-on-chronic liver failure(HBV-ACLF)has poor prognosis with high short term mortality and poor response to treatment leading to long-term hospitalization.It is the most common cause of death related with liver in our country.The incidence has increased in recent years.But it is distinct from mere the end-stage of liver disease.Patients may be better if they could be teated timely.Many experts have studied on it from univariate analysis to multivariate analysis and build many models for evaluating outcome about liver disease.There is no specific model about evaluating the prognosis of HBV-ACLF as so far.The applying frequency of each score in the clinical work and praise and abuse of different scores is different.This study choose the model of end-stage with incorporation of serum sodium(MELD-Na)score and Chronic liver failure-sequential organ failure assessment(CLIF-SOFA)score which have been usually used and were based on European and Amecican people.Also this study choose the Asian Pacific Assocaition for the Study of the Liver(APASL)ACLF Research Consortium score(AARC-ACLF)which is newly established these years and is based on Asians ACLF.There are some differences between Asian-Pacific region and European and Amecica about ACLF.As the cause of liver injury is different in different district,the definition and estimation of prognosis of ACLF are different.The definition of ACLF between our country and APASL is similar.But AARC-ACLF has not been used widely in our country.We don’t know if these scores can be adapted to our country’s criterion and they should be discussed and researched further more.To investigate the value for diagnosisng short-term prediction of MELD-Na,CLIF-SOFA and APASL-ACLF scor for evaluation of prognosis of HBV-ACLF.MethodsA total of 72 consecutive patients with HBV-ACLF were included in the study and divided into two groups(A group and B group)according to the prognosis which was diagnosed lasting for 3 months.A group were survival after medical treatment at least for 3 months and B group were received liver transplantation or death after treatment as failure of medical treatment.When the patients were diagnosed ACLF or after admission,the data were collected.Choosing the homochronous laboratory examination.Age,PT,INR,PTA,TBIL,AFP,NH3,Cr,PH,ALB,Na,LAC,CHE,MAP,MELD-Na,CLIF-SOFA,AARC-ACLF Scores and other indexes were calculated respectively and the comparative analysis was performed.Areas under the receiver operating characteristic curve(AUROC)of MELD-Na and CLIF-SOFA Scores were used to assess diagnosing the short-term prognosis in patients with HBV-ACLF.ResultsThe value of PT,TBIL,INR,PTA,MELD-Na,AARC-ACLF and CLIF-SOFA were significantly higher in B group than those in A group(P<0.05).The serum level of Na was significantly lower in B group than that of A group(P<0.05).Age,Cr,ALB,CHE,AFP,NH3,PH,LAC and MAP did not have significant difference.The area under curve(AUC)values generated by the ROC curves was higher for CLIF-SOFA score(AUC 0.887)than that of MELD-Na score(AUC 0.764)(Z 2.255,P<0.0167).The area under curve(AUC)values generated by the ROC curves did not have significant difference between CLIF-SOFA score(AUC 0.887)and AARC-ACLF score(AUC 0.820)(Z=1.361,P>0.0167)or MELD-Na score(AUC=0.764)and AARC-ACLF score(AUC 0.825)(Z=1.127,P>0.0167).The cut-off scores of MELD-Na,CLIF-SOFA and AARC-ACLF were 23.84,8.50,8.50 respectively.ConclusionMELD-Na,CLIF-SOFA and AARC-ACLF scores all have appreciable value to evaluate the prognosis in patients with HBV-ACLF.AARC-ACLF is better than that of MELD-Na and CLIF-SOFA in assessing prognosis of HBV-ACLF for clinical use which is based on Asians and obtained easily. |
