Analysis And Prediction Of Prognostic Factors For Short-term Outcome In Patients With Liver Failure Treated By Artificial Liver Support System

Aims:To explore the influencing factors of the short-term efficacy of artificial liver support system(ALSS)in patients with liver failure,and to predict the efficacy of ALSS more accurately,so as to guide the choice of clinical treatment for patients with liver failure.Methods:In this study,91 patients with liver failure treated by ALSS in our hospital from December 2015 to December 2018 were enrolled through medical record inquiry system.According to the clinical effect of discharged patients,the patients were divided into two groups:the improved group and the unhealed group.The clinical data(age,sex,past medical history,etc.),laboratory indicators,etiology and prognosis were retrospectively analyzed.The effect of ALSS on patients with liver failure was objectively evaluated,and the related factors affecting the short-term efficacy were further analyzed.Data were collected by Excel 2007 and analyzed by SPSS22.0 software.Results:1.A total of 91 patients treated with ALSS were collected in this study.49patients improved after treatment and 42 patients did not recover.Among them,73were males and 18 were females,with an average age of 49.13±11.31.Among the etiological classification,the most cases were HBV infection,accounting for 68.31%.2.Compare the basic characteristics of patients with different prognosis:The age of the unhealed group was greater than that of the effective group,and the difference was statistically significant(p=0.002).Comparing the improvement rates of different types of ALSS,the results showed statistically significant differences(p=0.021).The curative effect of patients with acute and subacute liver failure in liver failure stage was better than that of patients in other stages.The rate of improvement in patients with chronic liver disease was significantly lower than in patients without history.The improvement rate of cirrhosis patients was significantly lower than that of non-cirrhosis patients(p=0.036).There was no statistical difference in the history of diabetes,the history of drinking,and whether or not the hormone was combined.3.Effect of changes of laboratory and post-treatment indicators on short-term efficacy of ALSS:The levels of TBIL,PT,and Cr in the unhealed group were higher than those in the effective group at admission,and the levels of ALB,PTA and Na~+in the unhealed group were lower than those in the effective group,with significant statistical differences(p<0.05).The rates of AST,ALT and TBIL decrease in the unhealed group after the first ALSS treatment were significantly lower than those in the effective group,with significant statistical significance(p<0.05).The total bilirubin rebound rate(TBRR)of the effective groups was lower than that of the ineffective therapy group,and the difference was statistically significant(p<0.05).There were no significant difference in blood routine,blood lipid,alpha fetoprotein(AFP)levels between the two groups(p>0.05).4.Complications of liver failure and complications in ALSS treatment and post-treatment affect short-term outcomes:The improvement rate of hepatic failure patients with hepatic encephalopathy or infection was significantly lower than those without complications(p<0.05).The proportion of adverse reactions in the effective group was 18.37%,which was lower than that in the unhealed group(81.63%).The difference was statistically significant(p=0.006).5.Effect of severe liver disease score on short-term efficacy:The CTP scores and MELD scores of the two groups were compared,and the difference was statistically significant(p<0.05).And the decrease rate of MELD score in the effective group after the first ALSS treatment was significantly higher than that in the unhealed group,and the difference was also statistically significant(p<0.05).6.Multivariate Logistic regression analysis showed that MELD score,Na~+,TBRR and Classification of hepatic failure were independent prognostic factors for the short-term efficacy of artificial liver support system in patients with liver failure.7.According to the independent risk factors studied,a multi-index combined prediction model was established.The prognostic index was calculated and the ROC curve was analyzed.The area under the curve was 0.910(0.853-0.966).And the prediction model established in this study is an ideal prognostic evaluation system for patients with liver failure who have undergone an ALSS treatment.Conclusion:1.MELD score,Na~+,TBRR and Classification of hepatic failure were independent prognostic factors for the short-term efficacy of artificial liver support system in patients with liver failure.2.The prediction model established in this study is an ideal prognostic evaluation system for patients with liver failure who have undergone an ALSS treatment.