| Objective: To investigate the causes of acute-on-chronic liver failure(ACLF)and clinical prognostic analysis.Methods: A retrospective analysis of 364 cases of inpatients provided in the Fifth Hospital of Shijiazhuang and other four infectious diseases hospitals of the province between June 2014 and September 2017.The diagnostic criteria adopted the Guidelines for the diagnosis and treatment of liver failure in China in 2012.The collected data includes: demographic characteristics such as age,gender,and BMI;HBV-related,infectious,drug,alcohol,and other predisposing factors;On admission(baseline)complications such as hepatic encephalopathy,spontaneous bacterial peritonitis,gastrointestinal bleeding,and electrolyte imbalance;Baseline blood biochemistry,HBVDNA,coagulation function,MELD scores;primary clinical data(TBIL,ALB,INR/PTA,PCT,etc.),outcome,and primary diagnosis at discharge on 7th,14 th,and 28 th day of discharge.Logistic regression was used to analyze the demographic characteristics,predisposing factors,and key factors affecting the outcome of ACLF.Result:1.Main causes of ACLF: HBV 79.4%(289/364),alcohol 6.87%(25/364),unexplained cause 6.32%(23/364),drug 2.47%(9/364),HCV 2.20%(8/ 364).2.The average age of patients with ACLF was 48.38±12.45 years,of which men(46.58±12.17 years)were lower than women(54.22±11.59 years)(P<0.05).The survival rate of HBV-ACLF patients in the 40-49 year old group(61.90%)was higher than that in the 60+ years old group(32.79%),and the age of the warts increased,and the survival rate showed a downward trend(P <0.05).Male to female sex ratio: HBV-ACLF 3.25:1,HCV-ACLF 0.6:1,alcohol-related ACLF 24:1,drug-related ACLF 0.3:1(P <0.001).The survival rate of patients with HBV-ACLF BMI was lower than the 18.5 group: 33.33%(2/6),18.5-23.9 group: 66.15%(43/65),24-27 group: 71.15%(37/52),28-32 groups: 62.6%(17/27),greater than 32 groups: 50%(4/8).There was no statistical difference(P >0.05).3.The survival rates of low viral load and moderate or above viral load were 50% and 53.96%,respectively,and the survival rate of a single precipitating factor(48.06%)and two or more precipitating factors(44.53%).There were no statistically significant differences(P >0.05).4.ACLF main causes: Intrahepatic factors: HBV-related(HBV activity,NA withdrawal,NA resistance)32.25%,drug 6.90%,alcohol 6.09%;Extrahepatic factors: infections(intra-abdominal infections,pulmonary infections,infections of unknown sites)32.45%,gastrointestinal bleeding 5.48%,gastrointestinal flora translocation 5.27%.5.There was no statistical difference between the 90-day survival rate of compensated liver cirrhosis and decompensated liver cirrhosis(44.53% vs 48.0%,P >0.05).6.Dichotomous variables Logistic regression analysis of risk factors for the clinical prognosis of ACLF revealed that age,TBIL,CTP score,and MELD score were independent risk factors,and the difference was statistically significant.Conclusions:1.The main causes of ACLF are HBV,alcohol,unexplained causes,drugs,hepatitis C,and autoimmune liver disease.2.The survival rate of HBV-ACLF was higher than that of non-HBV-related ACLF.The survival rate of HBV-ACLF decreased with age,and the survival rate of males was lower than that of women.BMI index and HBV DNA load did not affect the survival rate of ACLF.3.Bacterial infections,HBV-related,drugs,alcohol,gastrointestinal bleeding,gastrointestinal flora translocation are the main incentives for ACLF;Among them,bacterial infections(mainly from the abdominal cavity,lungs,biliary tract,skin,urinary system),HBV-related(HBV activity,NA withdrawal,NA resistance)is the most important.One or more predisposing factors have no significant effect on the outcome of ACLF.4.The survival rate of chronic liver disease based on ACLF is significantly higher than that based on cirrhosis,but the short-term survival rate of decompensated liver cirrhosis is not lower than that of compensated liver cirrhosis.5.INR,TBIL,CTP score and MELD score is effective index of the evaluation for ACLF prognosis. |
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