Analysis Of The Clinical Charactetistics,early Warning And Prognosis In 296 Patients With Acute On Chronic Liver Failure

Objective:Acute on chronic liver failure(ACLF)is a clinical syndrome characterised by an acute deterioration of liver function associated with one or more organ failuers and high short-term mortality rate and poor prognosis,which arouse wide concern.Therefore,early diagnosis,evaluation of prognosis and timely intervention can improve the survival rate and the timing of liver transplantation in patients with ACLF.This artical analyzes the clinical features and prognosis of 296 patients with ACLF in order to clinical doctor comprehend this disease better,and to prevent of ACLF,and to evaluate the prognosis of it.Methods:1.Subjects:Patients from the first hospital of Jilin University who were hospitalised for at least 1day with severe liver injury(TB ?5mg/dL)from CHB or acute decompensation of cirrhosis(ascites/HE/upper gastrointestinal haemorrhage bacterial infection)of all aetiologies were initially screened and enrolled in this study.It include 612 had an HBV aetiology with a diagnostic history of CHB(104 with non-cirrhosis,508 with acute decompensation of cirrhosis),and 476 had acute decompensation of cirrhosis caused by non-HBV aetiologies.2.Detection:The clinical indictors including liver function,blood toutine,congulaton,renal function,ion,HBV markers,HBV-DNA loading,alpha fetoprotein were detected.3.Statistical analysis:In univariate statistical analyses,the ?2 test was used for categorical variables and Student's t-test and the Mann-Whitney U test were used for continuous variables.The results are presented as frequencies and percentages or means and SD.Variables with statistically significant differences in univariate analysis were included in the logistic regression analysis.P<0.05 was considered statistically significant.The scores were assessed and compared using the same methods applied to the derivation data.SPSS software.Results:1.A total of 1088 patients with CHB and severe liver injury(TB ?5mg/dL)or with acute decompensation of cirrhosis were enrolled in this study;612(56%)had an HBV aetiology with a diagnostic history of CHB(104(10%)with non-cirrhosis,508(46%)with acute decompensation of cirrhosis),and 476(44%)had acute decompensation of cirrhosis caused by non-HBV aetiologies.Of the patients assessed using EASL-ACLF criteria without the diagnostic indicator of cirrhosis,296(25%)were diagnosed with ACLF(29(3%)with non-cirrhotic HBV-ACLF,135(12%)with cirrhotic HBV-ACLF and 132(12%)with non-HBV-ACLF),and 792(75%)patients were diagnosed with non-ACLF(79(7%)with‘mere'HBV-severe liver injury without cirrhosis,373(34%)with‘mere'HBV-acute decompensation of cirrhosis and 344(32%)with‘mere'non-HBV-acute decompensation of cirrhosis).All the HBVDNA-positive patients received antiviral therapy after hospital admission.Twelve patients in these groups received a liver transplant.2.296 patients with ACLF were enrolled in this study;109(36.8%)had an HBV aetiology;3(1.0%)had HBV superimposed with other hepatitis with virus;47(15.9%)had HBV + alcohol;5(1.7%)had HBV + other causes;20(30.1%)had autoimmune liver diseases(PBC,AIH,PSC,undefined);89(30.10%)had alcohol liver disease.7(2.4%)had cryptogenic liver disease;10(3.4%)had Hepatisis C infection;4(1.4%)had nonalcohol fatty disease;2(0.7%)had Chronic drug-induced liver disease.3.The potential precipitating events of all patients with ACLF:134(45.3%)had Bacterial infection;77(26.0%)had active alcohol intaking during the past 3 months(more than 1000 ml beer,400 ml wine or 100 ml hard liquor per week in men and more than 750 ml beer,250 ml wine or 75 ml hard liquor per week in women);78(26.4%)had undefined;44(14.9%)had gastrointestinal bleeding;28(9.5%)had hepatotoxic drugs or herbs;19(6.4%)had stop using antivirals.5(1.7%)had surgery in past 3 months.4(1.4%)had physiological exthaustion;4(1.4%)had portal vein Thrombosis;HBV-ACLF compared with Non-HBV ACLF:The potential precipitating events(Bacterial infection,active alcohol intaking,undefined,gastrointestinal bleeding,hepatotoxic drugs or herbs,stop using antivirals)are statistically significant.(Bacterial infection P=0.00,active alcohol intaking P=0.00,undefined P=0.03,gastrointestinal bleeding P=0.00,hepatotoxic drugs or herbs P=0.02,stop using antivirals P=0.00)are statistically significant.4.Patients were diagnosed with ACFL at enrollment,179(79.6%)had liver failure;142(63.1%)had coagulation failure;67(29.8%)had renal failure;26(11.6%)had cerebral failure;12(5.3%)had circulation failure;18(8.0%)had lungs failure;33(14.7%)had renal dysfunction;88 had hepatic encephalopathy I or II.HBV-ACLF compared with Non-HBV ACLF:organs failure(liver failure;coagulation failure;renal failure;circulation failure;renal dysfunction)are statistically significant(liver failure P=0.00;coagulation failure P=0.00;renal failure P=0.02;circulation failure P=0.01;renal dysfunction P=0.00);Patients with ACLF in this study compared with in CANONIC:organs failure(liver failure;coagulation failure;renal failure;cerebral failure,circulation failure)are statistically significant.(liver failure P=0.00;coagulation failure P=0.00;renal failure P=0.00;cerebral failure P=0.00,circulation failure P=0.00).5.The mortality of ACFL1(n=67)is 40.3%(27/67)in 28 d and 59.7%(40/67)in 90d;The mortality of ACFL2(n=119)is 47.9%(57/119)in 28 d and 58.8%(70/119)in 90d;The mortality of ACFL3(n=38)is 76.3%(29/38)in 28 d and 84.2%(32/38)in 90d;comparion of the mortality in ACFL1?ACLF2 and ACLF3:P=0.005).6.The aetiology of 267 patients with cirrhotic ACLF in this study:89(33.3%)had an HBV aetiology;46(17.2%)had HBV+other causes;89(33.3%)had alcohol liver disease;43(16.1%)had other causes;the complication of the patients:217(81.3%)had ascites;43(16.1%)had upper gastrointestinal haemorrhage;89(33.3%)had HE;119(44.6%)had bacterial infection,128(47.9%)were died in 28d;168(63.3%)were died in 90d;cirrhotic HBV-ACLF compared with cirrhotic Non-HBV ACLF:aetiology,the complication(upper gastrointestinal haemorrhage,bacterial infection),the indicator of labortory(AST,TB,creatinine,serum sodium,WBC,neutrophil,NLR,INR,MELD)are statistically significant.(aetiologyP=0.00,upper gastrointestinal haemorrhage P=0.01,bacterial infection P=0.00,AST P<0.01,TB P<0.01,creati-nine P<0.01,serum sodium P<0.01,WBC P<0.01,neutrophil P<0.01,NLR P=0.03,INR P<0.01,MELD P<0.01).7.A total of 1088 patients were separated into Three subgroups in this study HBV-severe liver injury(non-cirrhosis),HBV acute decompensation(cirihosis),non-HB V acute decompensation(cirihosis);comparisons between patients with non-ACLF and patients with ACLF in the CHB with severe liver injury(age,HE?ascites,bacterial infection,?-GT,TB,creatinine,serum sodium,WBC,neutrophil,NLR,INR,liver failuer,coagulation failure,the 28 d mortality,the 90 d mortality,MELD P<0.05),CHB with decompensation(age,HBV-DNA,renal dysfunction,HE,ascites,upper gastrointestinal haemorrhage,bacterial infection,AST,TB,creatinine,serum sodium,WBC,neutrophil,NLR,INR,liver failuer,coagulation failure,renal failure;cerebral failuer,MELD,the 28 d mortality,the 90 d mortality,P<0.05)and non-HBV with decompensation groups(age,sex,aetiology,renal dysfunction,HE,upper gastrointestinal haemorrhage,bacterial infection,AST,TB,creatinine,WBC,neutrophil,NLR,INR,liver failuer,coagulation failure,renal failure,cerebral failuer,circulation failure,lungs failure,MELD,the 28 d mortality,the 90 d mortality,P<0.05)are statistically significant.8.Survival group was compared to the death group in 28 d and 90 d with ACLF: age,AST,TB,creatinine,WBC,neutrophil,NLR,INR,MELD are statistically significant(P<0.05).the variables were bringed into univariate and multivariate in Logstic,we can see: age,NLR,INR,MELD are prognostic independent prognostic factors.Conclusions:1.25% of patients were diagnosed ACLF,and its morbidity is higher in this study.2.The main aitiology of ACLF is HBV infection,alcoholic liver disease and HBV infection combined alcoholic liver disaese;The main potential precipitating events of all patients with ACLF is bacterial infection and active drinking,unknown,the main organs failuer is liver failuer and coagulation failure.3.The elevation of WBC,neutrophile grannulocyte,NLR,INR,MELD and the reduction of serum sodium are the early warning of ACLF.4.Age,NLR,INR,MELD are prognostic independent prognostic factors of ACLF.