| Objective:To investigate the risk factors for the progression to acute-on-chronic liver failure(ACLF)in patients with acute exacerbation of chronic hepatitis B(AE-CHB)and compare the predictive values of six scoring models.Methods:A retrospective case-control study was used to analyze the clinical data of275 AE-CHB patients admitted to our hospital from January 2011 to June 2019.They were divided into ACLF groups and non-ACLF group based on whether ACLF occurred within 28 days.SPSS 19.0 software was used to analyze difference in clinical characteristics between the two groups of patients.Two independent samples t test was used to compare normally distributed data,and the results were expressed as mean±standard deviation(?x±s).Mann-Whitney U test was used to compare non-normally distributed data,and the results were expressed as median and interquartile range[M(P25,P75)].The comparison between the two groups of count data was made by the chi-square(?~2)test,and the results were expressed as a rate.We further calculated the scores of six scoring models,including model for end-stage liver disease(MELD),model for end-stage liver disease-Na(MELD-Na),integrated MELD(iMELD),age,serum bilirubin,international normalized ratio and serum creatinine(ABIC),score of Chinese Group on the Study of Severe Hepatitis B-related acute-on-chronic liver failure(COSSH-ACLFs)and model of R(R)established by Ren et al,and compared the relationship between their scores with the incidence of ACLF.Receiver operating characteristic(ROC)curves and the area under the curve(AUC)were used to evaluate the predictive value of the six scoring models.Results:1.Between ACLF group and non-ACLF group,hepatitis B virus e antigen(HBeAg)-negative,age,HBV DNA,total bilirubin(TBIL),cholinesterase(CHE),albumin(ALB),prothrombin time(PT),activated partial prothrombin time(APTT),prothrombin activity(PTA),INR,platelet(PLT),aspartate transaminase-to-platelet ratio index(APRI),fibrosis index based on the 4 factors(FIB-4)were significantly different.2.Logistic regression analysis showed that age,INR and HBV DNA were the independent risk factors associated with the development of ACLF.3.The scores of six models were significantly higher than those in non-ACLF group,and the scores were positively correlated with the incidence of ACLF.The AUC of the ABIC,iMELD,MELD,MELD-Na models(AUC=0.785,95%CI 0.731-0.832.AUC=0.773,95%CI 0.719-0.821.AUC=0.771,95%CI 0.717-0.820.AUC=0.751,95%CI0.696-0.801)is greater than 0.7,indicating they both had certain diagnostic values.The AUC of the R and COSSH-ACLFs model(AUC=0.864,95%CI 0.817-0.902.AUC=0.822,95%CI 0.772-0.866)is greater than 0.8,indicating they both had better diagnostic values.Conclusions:HBeAg-negative,old age,high levels of HBV DNA,TBIL,PT,APTT,INR,APRI,FIB-4 and low levels of CHE,ALB,PTA,and PLT are risk factors for progression to ACLF in patients with AE-CHB.The independent risk factors are age,INR and HBV DNA.The scores of the six scoring models are positively correlated with the incidence of ACLF.The AUC of the R model is the largest,and the models of R and COSSH-ACLFs have the better predictive value on the progression to ACLF in patients with AE-CHB.iMELD,ABIC,MELD and MELD-Na models all have certain predictive value. |
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