The Prognosis?Analysis Of Prognostic Factors And Prognostic Evaluation In Patients With Decompensated Cirrhosis

Obiective:To investigate the prognosis and prognostic risk factors in patients with decompensated cirrhosis.The prognostic value of various prognostic models of cirrhosis was compared in 3,6,9and 12 months.Methods:1.A total of 545 patients diagnosed with decompensated cirrhosis were selected from October 20,2018 to July 20,2019 and were admitted to the First Hospital of Jilin University,482 patients were enrolled after 63 patients were removed who have lost follow-up,developed into liver cancer and performed liver transplantation.Record the general information,the history,laboratory examinations and imaging informations of the above patiens acquired in the first time after admission.The above patiens were followed up by telephone or hospital medical records until happen the terminal event or the end of the study(the end time of the study is on March 1,2020),survival rates of patients in various situations been counted after the follow-up,The informations of 292 patients who were followed among 12 months were setted up a database and were processed by SPSS19.The t-test,rank-sum test,chi-square were used to compare the two sets of measurement and count data of survival group and death group.Logistic was used to further analyze the above-mentioned results with meaningful results.When P<0.05,it was considered as statistically significant.2.According to patient datas,scores of various prognostic models of cirrhosis were calculated,and their predictive value was compared by the area under the curve(AUC)of the receiver operating characteristic curve(ROC).Results:1.By the end of follow-up,the 3-month,6-month,9-month,and 12-month survival rates of hospitalized patients with decompensated cirrhosis were 91.1%(439/482),87.8%(423/482),83.5%(333/399),and 76.4%(223/292)respectively.2.Patients with alcoholic decompensated cirrhosis have the lowest survival rates compared to other etiology,a survival rate of 61.1% within 12 months after discharge.The survival rates of patients be complicated by infection,ascites and upper gastrointestinal bleeding with different etiology were analyzed.The survival rate of patients with HBV-related decompensated cirrhosis complicated with ascites was lower,But in patients with alcohol-related patients,infection had the greatest influence on poor prognosis,but there was no significant difference in survival rate among patients with these three complications.3.Infection(54.77%),ascites(51.04%)and upper gastrointestinal bleeding(29.08%)were the most common complications in 482 patients with decompensated cirrhosis.Among the patients with one complication,the survival rate of the patients with hepatorenal syndrome was the lowest(41.7%),followed by hepatic encephalopathy and ACLF.The survival rate was lowest when both complications were combined with hepatorenal syndrome and ascites.Patients with any 2 or less 2 of the 7 complications including HE,infection,hepatorenal syndrome,ascites,ACLF,upper gastrointestinal bleeding and portal vein thrombosis,the survival rate within 3 months after discharge was 95.5%.The survival rate within 3 months after discharge was 68.4% in patients with any two or more complications.4.After univariate anlysis,AST,ALT,Alb,TBil,Na,WBC,the neutrophil,the lymphocyte,the monocyte,LMR,NLR,INR,PTA,cholesterol,HDL-C,LDL-C,etiology,HE,infection,hepatorenal syndrome,ascites,ACLF,history of splenectomy and upper gastrointestinal bleeding related to the survival of patients with decompensated cirrhosis.5.After binary logistic regression analysis,Massive ascites,Moderate ascites,infection and decompensated cirrhosis caused by unknown causes were influence factors for mortality 12 months after discharge.6.The NLR combined with iMELD score are superior to ALBI,NLR,CTP,CrCTP,mCTP,MELD,MESO,MELD-Na and iMELD scores in evaluating the prognosis of decompensated cirrhosis.Conclusions:1.Patients with alcoholic decompensated cirrhosis have the highest mortality compared to other etiology;The more decompensated cirrhosis patients complicated with complications,the lower the survival rate.2.After univariate anlysis and binary logistic regression analysis,Massive ascites,Moderate ascites,infection and decompensated cirrhosis caused by unknown causes were influence factors for mortality 12 months after discharge.3.The NLR combined with iMELD score are superior to ALBI,NLR,CTP,CrCTP,mCTP,MELD,MESO,MELD-Na and iMELD scores in evaluating the prognosis of decompensated cirrhosis.