| Objective:Acute-on-chronic liver failure(ACLF),which is characterized by rapid deterioration of liver function and multiorgan failure,has high mortality,but there is a lack of effective treatment strategies currently.The accurate and effective assessment of the prognosis of patients is significantly important to guide clinical treatment as soon as possible.At present,the commonly used prognostic scoring models(CTP score、MELD score、MELD-Na score、CLIF-C OFs score、CLIF-SOFA score and CLIF-ACLF score)are mostly based on research data from western populations,and whether they are applicable to the Chinese population based on chronic hepatitis B remains to be studied.Recently,European and American scholars have reported that serum lactate can be used as an indicator to predict the prognosis of patients with cirrhosis or ACLF,and whether it can be applied to predict the prognosis of ACLF in Chinese remains to be confirmed.The purpose of this study was to confirm the predictive value of prognostic scores and lactate of patients with ACLF in short-term and long-term,which can promote early treatment and thereby improve patient survival.Methods:The Clinical information including demographic data,complications,hematological tests and treatment measures within 24 hours of admission were collected from hospitalized patients diagnosed as ACLF in our hospital from January2015 to December 2019,and calculate the above prognostic score models.The AUROC comparison and De Long test were used to evaluate the prognostic ability of ACLF patients in predicting short-term(28 days),medium-term(3 months)and long-term(6 months)outcomes of each model score.Univariate and multivariate logistic regression analyses were used to screen independent prognostic factors.Results:A total of 92 patients with ACLF were included in this study,there were 59HBV-ACLF patients,and 47(46.1%),58(56.9%)and 61(59.8%)died during 28 days,3 months and 6 months follow-up,respectively.At 28 days,the AUROC of CTP,MELD,MELD-Na,CLIF-C OF,CLIF-SOFA and CLIF-ACLF scores were 0.707,0.673,0.606,0.712,0.805 and 0.741,respectively(P<0.050).At 3 months,the AUROC of six scores were 0.641,0.715,0.664,0.709,0.751 and 0.729,respectively(P<0.050).At 6 months,the AUROC of the six scores were 0.640,0.708,0.655,0.716,0.742 and 0.725,respectively(P<0.050).The areas under the ROC curve(AUROCs)of the CLIF-SOFA score were higher than those of other scores at all time points.The comparison of the AUROC of the CLIF-SOFA score with other scores was statistically significant at 28 days(P<0.050),which was the only time point at which it was greater than 0.800.Univariate and multivariate Logistic regression analyses had screened out lactate(Lac)as a risk factor for the mortality in ACLF patients.The AUROCs of new scores by adding lactate(Child-Pugh+lactate score,MELD+lactate score,MELD-Na+lactate score,CLIF-C OF+lactate score,CLIF-SOFA+lactate score,CLIF-C ACLF+lactate score)were superior to those of existing scores,particularly the MELD score and MELD-Na score(P<0.050)at all time points,The AUROC of CLIF-SOFA score in HBV-ACLF patients was 0.848,0.791 and 0.764 at 28-days,3-months and 6-months,respectively(P<0.050).Conclusion:1、CTP,MELD,MELD-Na,CLIF-C OF,CLIF-SOFA and CLIF-ACLF scores are effective tools for assessing the prognosis of ACLF patients.These six prognostic models are applicable to Chinese patients and also applicable to HBV-ACLF patients;and the CLIF-SOFA score is especially effective for evaluating mortality at all time point.2、Serum lactate can be used as an effective indicator to predict the short-term and long-term mortality in HBV-ACLF patients,and the predictive value of the MELD score and MELD-Na was improved by adjusting for lactate.Lactate testing at admission can be beneficial in prognostic assessment and clinical decision-making. |
