| ObjectiveTo investigate clinical features and the accuracy of prognostic scoring models of patients with acute-on-chronic liver failure(ACLF)with different basic liver diseases.MethodsRetrospectively analyzed the clinical data of 262 patients with ACLF admitted to the Department of Infectious Diseases of the First Affiliated Hospital of Anhui Medical University from January 2017 to December 2018.Patients with ACLF were divided into three subtypes:type A(non-cirrhotic chronic liver disease),type B(compensated cirrhosis),and type C(decompensated cirrhosis)according to the different underlying chronic liver disease.The differences in the laboratory indicators,complication rate,the prognostic score model and short-term death risk factors of the three groups were analyzed.The measurement data in accordance with the normal distribution are expressed as(x±s),analysis of variance was used for comparison among groups;The measurement data that did not conform to normal distribution were expressed by median and quartile,and Kruskal-Wallis H test was used for comparison among groups;theχ~2 test was used to compare the count data.Time survival curve(Kaplan-Meier method),namely K-M survival curve,was used to compare the survival advantages of the three groups of patients.Apply receiver operating characteristic curve(ROC curve)to evaluate four scoring models:Child-Pugh,MELD,CLIF-C ACLFs,COSSH-ACLFs which predicting the 28-day and 90-day prognostic survival of all patients with ACLF and three different subtypes of patients aith ACLF at baseline.Multivariate COX regression was used to analyze the risk factors related to short-term death in patients with ACLF.ResultsThere was no significant difference in age between the three groups(P>0.05),there were significant differences in the composition ratio with the causes of hepatitis B virus(HBV)infection and gender among the three groups(P<0.05),but the three groups are mainly HBV infection and males,that is,there were no significant differences in gender,age and etiology between the three groups.There was no significant difference between the three groups of serum total bilirubin(TBIL),prothrombin international standard value(INR)and creatinine(Cr)(P>0.05);the serum albumin(ALB)of type A and type B patients was significantly higher than that of type C patients(P<0.05);the serum urea nitrogen(BUN)of type A and type B patients was significantly lower than that of type C patients(P<0.05);the platelet count(PLT)of type A patients was significantly higher than that of type B and C patients,and the PLT of type B patients was significantly higher than that of type C patients(P<0.05).The incidence of ascites and bacterial infections in type C patients were 70.6%and 47.1%,respectively,which were significantly higher than62.1%and 33.3%in type B patients and 40.7%and 22.2%in type A patients(P<0.05).The 28-day and 90-day survival rates of group A were 63.0%and 59.3%,respectively,which were not significantly different from 69.0%and 57.5%of group B and 56.9%and47.1%of group C(P>0.05).Compared with the 28-/90-day survival advantage of the three groups,the survival advantage of type B patients was the largest,followed by type A,and the survival advantage of type C patients was the smallest.Comparing the performance of Child-Pugh,MELD,CLIF-C ACLFs,COSSH-ACLFs modelsin predicting the short-term mortality of ACLF patients,MELD,CLIF-C ACLFs,COSSH-ACLFs are significantly better than Child-Pugh;COSSH-ACLFs has a good ability to predict the prognosis of patients with ACLF.Alanine aminotransferase(ALT)level is negatively correlated with 90-day mortality rate of patients with ACLF,while aspartate aminotrans-ferase(AST),creatinine(Cr),total bilirubin,prothrombin international standard values and hepatic encephalopathy are positively correlated with the 90-day mortality rate of patients with ACLF.ConclusionThe clinical features and complications of ACLF patients with different basic liver diseases are significantly different,and the prognosis of the three subtypes of ACLF showed a difference trend.The COSSH-ACLFs scoring model has a better ability to predict the prognosis of ACLF patients.Serum alanine aminotransferase,aspartate aminotrans-ferase,total bilirubin,creatinine,prothrombin international standard values and hepatic encephalopathy are high risk factors for 90-day death in ACLF patients. |
