Application Of Serum Lipid Profile In The Diagnosis And Predicting Prognosis In Patients With Acute-on-chronic Liver Failure

Objective: The liver is the main site of lipid metabolism.Lipid metabolism disorder is one of the common complications in patients with advanced liver cirrhosis and liver failure.Early diagnosis can reduce mortality in patients with acute-on-chronic liver failure(ACLF).The study aims to investigate the possible association between serum lipid profile and the severity of liver cirrhosis and the occurrence of acute-on-chronic liver failure(ACLF).Methods: This study recruited 297 patients with cirrhosis,including 103Child-Pugh A(CA),104 Child-Pugh B(CB),90 Child-Pugh C(CC)patients,and 64 patients with ACLF.Biochemical examinations of blood were obtained after overnight fasting.We evaluated the relationship between lipid levels,the severity of liver cirrhosis and the occurrence of acute-on-chronic liver failure.Results: The levels of cholesterol(CHOL),high density lipoprotein cholesterol(HDL),apolipoprotein A(apo A)in patients with ACLF were significantly lower than those in CC,CB and CA groups(P<0.001);CC patients had lower CHOL value than CB(P<0.001);CB patients had lower CHOL,HDL,apoA value than CA(P<0.05).These results indicated that serum lipid levels decreased in pallel with the increased severity of liver disease.CHOL,apoA levels were negatively correlated with MELD score(r =-0.371,-0.412,P=0.004,0.001,respectively).HDL,apoA levels were negatively correlated with TBIL(r =-0.417,-0.507,P=0.001 and <0.001,respectively).The area under the ROC curves for 1/CHOL,1/HDL,1/apoA,MELD score were 0.84,0.90,0.89 and 0.96(P<0.001),respectively.Conclusions:1.The decreased levels of CHOL,HDL and apoA may reflect the severity of cirrhosis;2.The decline in CHOL,HDL,and apoA may predict the occurrence of ACLF in cirrhotic patients.