Effect Of Plasma Osmotic Pressure On The Prognosis Of Patients With Hbv-related Acute On Chronic Liver Failure

Objective: To analyze the characteristics of plasma osmotic pressure in patients with chronic hepatitis B associated with acute liver failure(HBV-ACLF),and to explore the correlation between plasma osmotic pressure and the prognosis of HBV-ACLF.Methods:A retrospective analysis of 131 cases of HBV-ACLF patients hospitalized in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to April 2017 was conducted.The plasma osmotic pressure,Cr,TBIL,ALB were collected for the first time after admission,PT,AST,ALT,INR,serum Na+ levels and other related indicators.According to the plasma osmolality,the patients were divided into groups and their mortality was calculated.According to the prognosis of the patients after 3 months of follow-up,they were divided into survival group and death group.Plasma osmotic pressure,Cr,TBIL,ALB,PT,AST were compared between the two groups.ALT,INR,serum Na+ levels,end-stage liver disease model(MELD)scores,and MELD-Na scores;osmotic pressure,MELD scores,and MELD-Na scores for Cr,ALB,INR,and serum Na+levels for HBV-using statistical methods The predictive value of ACLF prognosis.Results: 1.The mortality rate of HBV-ACLF patients with plasma osmolality less than270 mmol/L was 100%;the mortality rate of HBV-ACLF patients with plasma osmolality<280(mmol/L)was 72.7%;280 The mortality rate of HBV-ACLF patients with pressure<290(mmol/L)was 17.7%;the mortality rate of HBV-ACLF patients with plasma osmolality> 290(mmol/L)was 12.5%;2.Plasma osmotic pressure,serum Na+concentration,The ALB,Cr,INR,MELD score,MELD-Na were different between the survival group and the death group(P<0.05),but there was no significant difference in TBIL,PT,AST,ALT between the survival group and the death group(P>0.05).).3.Non-conditional logistic regression analysis showed that plasma osmotic pressure(OR=0.82,P<0.05),ALB(OR=0.83,P<0.05),Cr(OR=1.016,P<0.05),INR(OR= 1.3,P<0.05),MELD score(OR=1.17,P<0.05)and MELD-Na score(OR=1.23,P<0.05)were all independent risk factors for the death of patients with HBV-ACLF.There was no significant correlation between plasma osmotic pressure and Cr,TBIL,ALB,PT,AST and ALT in patients with chronic hepatitis B virus-associated chronic liver failure(P>0.05).Plasma osmolality was positively correlated with Na+ concentration in patients with HBV-ACLF(r=0.59,P<0.01),plasma osmotic pressure and INR in patients with chronic hepatitis B virus-associated chronic liver failure(r=-0.23,P=0.01),MELD Scores(r=-0.25,P=0.03)and MELD-Na scores were negatively correlated(r=-0.51,P<0.01).Conclusion: 1.Plasma osmotic pressure is closely related to the mortality of HBV-ACLF patients.The lower the plasma osmotic pressure,the higher the mortality rate.Plasma osmolality,ALB,Cr,INR,MELD-Na score,MELD score were all independent risk factors for the death of patients with HBV-ACLF.The plasma osmolality of patients with HBV-ACLF was positively correlated with Na+ concentration and negatively correlated with INR,MELD score,and MELD-Na score,suggesting that plasma osmotic pressure should be emphasized in clinical practice.Early treatment with early intervention should reduce mortality.