| Objective:The purpose of this study is to explore the risk factors associated with progression of patients with acute exacerbation of hepatitis B virus-related compensatory liver cirrhosis(AE-LCB)to acute-on-chronic liver failure(ACLF)and establish a predicting model.Methods:237 patients with AE-LCB admitted to the Department of Infectious Diseases of Zunyi Medical University from January 2011 to June 2019 were included in this retrospective analysis.We divided the patients into ACLF group(n=48)and Non-ACLF group(n=189)according to whether they progressed to ACLF within 28days after admission.Baseline demographics characteristics,biochemical or viral indicators within 24 hours after admission were compared between patients with and without progression to ACLF using the?~2 for categorical variables,the t test for variables with normal distribution,and Mann-Whitney U test for variables with an abnormal distribution.Continuous variables were summarized as mean±standard deviation(SD)or median inter-quartile range(IQR),respectively.The categorical variables were displayed as counts or percentages(%).Logistic regression analysis was used for univariate and multivariate analysis.Finally,we were establish a new prognostic model for predicting the development of ACLF in patients with AE-LCB,and compared the predictive value with that of child-turcotte-pugh(CTP),model for end-stage liver disease(MELD),model for end-stage liver disease-Na(MELD-Na),integrated MELD(iMELD),chronic liver failure-sequential organ failure assessment(CLIF-SOFA),Chinese group on the study of severe hepatitis B-ACLF score(COSSH-ACLFs).The predictive value was evaluated by the receiver operating characteristic(ROC)curve and the area under the curve(AUC).Results:1.A total of 237 patients who met the inclusion and exclusion criteria were collected.48 patients developed to ACLF within 28 days of admission,including 44men and 4 women.189 patients did not developed to ACLF within 28 days of admission,including 165 men and 24 women.2.Univariate-logistic regression analysis found that bacterial infection,Na~+,alkaline phosphatase(ALP),glutamyltransferase(GGT),total bilirubin(TBIL),albumin(ALB),prealbumin(PA),prothrombin time(PT),activated partial prothrombin time(APTT),international normalized ratio(INR),prothrombin activity(PTA),neutrophile granulocyte(NEUT),platelet(PLT),total cholesterol(TC),aspartate transaminase/alanine aminotransferase(AAR)and Loks index were the risk factors associated with progression to ACLF in patients with AE-LCB.Multi-variate logistic regression showed that bacterial infection,high serum level of INR,TBIL,low serum level of GGT,PLT were the independent risk factors associated with progression to ACLF.3.Compared with those of CTP,MELD,MELD-Na,iMELD,CLIF-SOFA,COSSH-ACLFs,our new model showed the largest area of ROC,and the highest Youden index among these scoring models.Conclusion:The independent risk factors are bacterial infection,high serum levels of INR and TBIL,and low serum levels of GGT and PLT.The predicting model established in this study has a good early warning effect in predicting the development of ACLF in patients with AE-LCB. |
