The Study On The Relationship Between Etiology,inducement And Clinical Prognosis Of 302 Patients With Liver Failure

Objective: To explore the relationship between the etiology and inducement of liver failure and its clinical prognosis,and to provide some help for the further prevention and treatment of liver failure and the reduction of mortality.Methods: Three hundred and two patients with liver failure were enrolled from The First Affiliated Hospital of Bengbu Medical College among January 2015 to June 2020.The diagnostic criteria were in line with the guidelines for the diagnosis and treatment of liver failure(2018 edition).Data were collected including gender,age and other demographic characteristics,etiology of liver failure,prenatal factors,and important laboratory indicators at admission,including white blood cells(WBC),red blood cell(RBC),hemoglobin(Hb),platelet(PLT),aspartate aminotransferase(AST),alanine aminotransferase(ALT),gamma-glutamyl transpeptidase(γ-GT),alkaline phosphatase(ALP),total bilirubin(TBIL),albumin(ALB),prothrombin time(PT),prothrombin activity(PTA),international standardization ratio(INR),sodium(Na+),potassium(K+,)chloride(Cl-),calcium ions(Ca2+),alpha-fetoprotein(AFP),hepatitis B virus nucleic acid load(HBV DNA).The CTP score and MELD score of each patient was calculated.The above indexes were retrospectively analyzed.Results: 1.The cause of liver failure were distributed as follows: 249 cases of single cause(82.5%),of which 157 cases of hepatitis B(52%),39 cases of alcohol(12.9%),28 cases of hepatitis E(9.3%),and 6 cases of drugs(2.0%),6 cases of autoimmune liver disease(2.0%),6 cases of unknown cause(2.0%),3 cases of hepatitis C(1%),2 cases of unclassified hepatitis virus(0.7%),2 cases of vascular disease(0.7%).53 cases(17.5%)of multiple causes,including 33 cases of hepatitis B and alcohol(10.9%),6 cases of hepatitis B and other viruses(2.0%)(other viruses were 3 cases of herpes virus,1 case of human parvovirus B19,untyped 2 cases of hepatitis virus),4 cases of hepatitis B and hepatitis E(1.3%),3 cases of hepatitis B and drugs(1.0%),2 cases of hepatitis B and hepatitis C(0.7%),1 case of alcohol and vascular disease(0.3%),1 case of hepatitis E and alcohol(0.3%),1 case of hepatitis B and biliary disease(0.3%),1 case of hepatitis C and autoimmune liver disease(0.3%),1 case of hepatitis B and hepatitis A(0.3%).2.The common causes of liver failure were the infection of 32 cases(10.60%),fatigue of 22 cases(7.28%),alcoholism of 20 cases(6.62%),irregular use of antiviral drugs of 19 cases(6.29%),14 cases(4.64%)of catching cold,self-discontinuation of 14 cases(4.64%),12 cases(3.97%)of drugs,combined with other hepatotropic virus infection of 8 cases(2.65%),gastrointestinal bleeding in 3 cases(0.99%),1 case(0.33%)of pregnancy and 157 cases of unknown cause(51.99%).3.The age of patients in the improved group was lower than that in the deteriorated group,and there was a significant difference between the two groups(P < 0.05).4.In patients with liver failure caused by hepatitis B,the level of HBV DBA in the improved group was lower than that in the deteriorated group,and there was a statistical difference between the two groups(P < 0.05).5.There were significant differences in the incidence of complications of hepatic encephalopathy,upper gastrointestinal hemorrhage,hepatorenal syndrome,electrolyte imbalance,and infection in the two groups(P < 0.05).Patients in the worsening group were more likely to have serious complications,such as hepatic encephalopathy,upper gastrointestinal bleeding,hepatorenal syndrome,electrolyte disturbance,and infection,than those in the improving group.6.The CTP and MELD scores in the improved group were lower than those in the worsening group,and the difference was statistically significant(P < 0.05).Conclusion: 1.The main cause of liver failure in our hospital is hepatitis B virus infection.2.The main risk factors for liver failure were co-infection,fatigue,alcoholism,and irregular use of antiviral drugs.3.The older the patients with liver failure,the worse the prognosis.4.The more kinds of complications of liver failure,the worse the prognosis.5.PLT,ALT,AST,ALP,TBIL,ALB,PT,INR,PTA,the scores of CTP and MELD in patients with liver failure at admission were important indicators affecting the prognosis.