Clinical Research Of Acute On Chronic Liver Failure Group In Hepatitis B Virus Related Cirrhotic Patients With Acute Decompensation

Background and aims: Researchers tend to use the single hepatic failure criteria(APASL criteria)to identify the HBV related ACLF patients.The greatest improvements in survival of ACLF patients probably result from identifying the patients with cirrhosis at greatest risk for organ failure at an early stage.To promptly predict the outcome of cirrhotic patients with AD is very important in clinic.Methods: 1511 hospitalized HBV-related cirrhotic patients with AD were consistently enrolled during 2005 to 2010 from Ren Ji and Rui Jin hospitals both affiliated to Shanghai Jiao Tong University,School of Medicne.After identifying patients with single hepatic failure at admission and within 28 days during hospitalization,multiple organ failures(MOF)(according to the EASL criteria of ACLF)were evaluated.The predicted performance of CLIF-C AD score,simplified MELD score for development of ACLF were evaluated.The risk factors of ACLF development were found by univariate and logistic progression analysis.Results: 645(42.7%)patients had single hepatic failure,while 67.3%(434/645)patients developed MOF.The MOF group had obviously rising trend of TB,Cr,INR,WBC values and MELD,MELD-Na,CLIF-OF scores;closer relation between WBC and 28 days' predicted mortality.higher 28 and 90 days mortalities and poorer one year's prognosis.The CLIF-C AD score perfectly predicted patients' development of ACLF within 28 days.Patients with CLIF-C AD score equal to or more than 50 were the high risk group to develop ACLF within 28 days.Patients were classified into low,middle,high and higher risk groups of high short term mortality according to simplified MELD score.Conclusion: For HBV-related cirrhotic patients with AD,the ACLF patients diagnosed by single hepatic failure criteria were a heterogeneous group.Patients with CLIF-C AD score euqual to or more than 50 were high risk group and should be carefully observed.The simplified MELD score could conveniently and exactly classify HBV related cirrhotic AD patients into different prognostic groups.