Clinical Characteristics And Short-term Prognostic Factors Of Patients With Acute-on-chronic Liver Failure With Different Etiologies

Objective:To explore the clinical characteristics and factors affecting short-term（90-day）prognosis of patients with hepatitis B related acute-on-chronic liver failure（HBV-ACLF）and alcoholic liver disease related acute-on-chronic liver failure（ALD-ACLF）,and establish short-term prognosis assessment models respectively.The evaluation models are used to guide the clinical identification of the short-term prognosis of ACLF patients with different etiologies and to take targeted treatment plans to improve the prognosis of ACLF patients.Methods:A retrospective analysis was performed on 66 patients with HBV-ACLF and 96 patients with ALD-ACLF in the First Affiliated Hospital of Dali University from January 2013 to July2021.First,the clinical data of HBV-ACLF group and ALD-ACLF group were compared and analyzed.Secondly,the 90-day prognostic factors in the HBV-ACLF group and the ALDACLF group were analyzed respectively,and the prognostic models were established respectively,the receiver operating characteristic curves were drawn,the areas under the curve were compared,and the optimal cut-off points,sensitivity,specificity and predictive power of each prognostic index were determined.SPSS20.0 software and Med Calc19.0.4software were used for data analysis.Results:1.Comparison of clinical data between HBV-ACLF group and ALD-ACLF group:Comparison of general data: The proportions of male patients and liver cirrhosis patients in the ALD-ACLF group were significantly higher than those in the HBV-ACLF group（P<0.05）.There were no statistically significant differences in the age distribution,proportion of ethnic minorities,and mortality between the two groups.Comparison of laboratory indicators: ALT,AST,ALB,K,RBC,and AFP in HBV-ACLF group were significantly higher than those in ALD-ACLF group（P<0.05）,while WBC,NEUT,NLR,and MONO were significantly lower than those in ALD-ACLF group（P<0.05）.Comparison of comorbidities: the incidences of ascites and infection in the ALD-ACLF group were significantly higher than those in the HBV-ACLF group（P<0.05）,but there was no significant difference in the incidence of gastrointestinal bleeding and hepatic encephalopathy between the two groups.In the ALDACLF group,pulmonary infection was the most common,with 46 cases（47.9%）,followed by spontaneous peritonitis with 24 cases（25.0%）.2.Among the 66 HBV-ACLF patients,53（80.3%）had liver failure,14（21.2%）had coagulation failure,8 had cerebral failure（12.1%）,and 7 had renal failure（10.6%）.Among the 96 ALD-ACLF patients,64（66.7%）had liver failure,15（15.6%）had coagulation failure,14（14.6%）had cerebral failure,and 6（6.3%）had renal failure.3.In the HBV-ACLF group,36 patients survived and 30 died within 90 days,with a case fatality rate of 45.5%.Logistic regression analysis showed that age,TBIL,and PT were independent risk factors for the 90-day prognosis of HBV-ACLF patients.Prognostic evaluation was established.Model: TAP=0.023×TBIL+0.203×Age+0.547×PT,the area under the ROC curve was 0.962,which is higher than MELD（0.875）（P=0.038）,the specificity was82.8%,the sensitivity was 96.3%,The optimal cut-off point was 28.07;the HosmerLemeshow test showed that the predictive power of the model was 85.7%.4.In the ALD-ACLF group,49 patients survived and 47 died within 90 days,with a case fatality rate of 49.0%.Logistic regression analysis showed that TBIL,PT,co-infection,and NLR were independent risk factors for the 90-day prognosis of ALD-ACLF patients.The prognostic evaluation model: TNP=0.013×TBIL+0.085×NLR+0.575×PT,the area under the ROC curve was 0.913,which was higher than MELD（0.781）（P=0.000）,the specificity was77.6%,the sensitivity was 87.2%,The optimal cut-off point was 16.34,and the HosmerLemeshow test showed that the predictive power of the model was 80.2%.Conclusion:ACLF patients have a high short-term mortality rate,and organ failure is mainly liver failure and coagulation failure.There are differences in clinical characteristics between HBVACLF patients and ALD-ACLF patients.The main manifestations are that the liver disease of ALD-ACLF patients is mainly cirrhosis and the incidence of infection is higher.TBIL,PT and age are independent risk factors for the short-term prognosis of HBV-ACLF patients.The predictive model TAP established in this study has a certain predictive value for the 90-day prognosis of HBV-ACLF patients.TBIL,PT,co-infection,and NLR are independent risk factors for the short-term prognosis of ALD-ACLF patients.The prediction model TNP established in this study has a certain predictive value for the 90-day prognosis of ALDACLF patients.