Risk Factors For The Development Of Liver Failure In Patients With Acute Exacerbation Of Chronic Hepatitis B Patients And The Comparison Of Predictive Value Of Four Liver Failure Warning Models

Objective:To study the risk factors for liver failure in patients with acute exacerbation(AE)of chronic hepatitis B patients,and to compare the predictive value of the four liver failure warning models.Methods:We retrospectively analyzed the medical records of 474 patients with AE of chronic hepatitis B patients admitted to the Department of Infectious Diseases of Affiliated Hospital of Zunyi Medical College from January 2011 to February 2017.Statistical analysis was performed by SPSS19.0 software.We calculated the scores of MELD score,MELD-Na score,Gao Fangyuan et al.(DT warning model)and Zhang Xuqing et al(SJY warning model),and compared the relationship between these scores and the incidence of ACLF in AE of chronic hepatitis B patients.The risk factors of developing ACLF in AE of chronic hepatitis B patients were indentified.The predictive value of these four warning models were evaluated by the receiver operating charcteristic(ROC)curve and the area under the curve(AUC).Results:1.474 patients with AE of chronic hepatitis B patients were included in this study.36 patients developed to ACLF after admission,438 patients did not progress to ACLF,by comparing the clinical and biochemical characteristics of 36 patients with ACLF and 438 patients without ACLF,we found that the difference of the 6 indexes including age ≥40 years old,HBV DNA ≥107copies/ml,serum sodium(Na~+),serum total bilirubin(TBIL),prothrombin activity(PTA)and international normalized ratio(INR)were statistically significant(P<0.05),suggesting that the development of ACLF was related to these factors;2.The incidence of ACLF is positively related to the value of MELD score,MELD-Na score,DT warning model score and SJY warning model score(P<0.05);3.The AUC of SJY and DT warning model were 0.84 and 0.79,respectively,both were higher than that of MELD(0.70)and MELD-Na(0.69).SJY warning model also had the highest sensitivity(0.86)and specificity(0.75).Conclusions : The risk factors for patients with AE of chronic hepatitis B patients progressing to ACLF include age ≥40 years old,HBV DNA ≥107copies/ml,low Na~+,high TBIL,prothrombin activity and international normalized ratio;The incidence of ACLF is positively related to the value of MELD score,MELD-Na score,DT warning model score and SJY warning model score;SJY and DT warning model have high sensitivity and specificity in predicting the development of ACLF in patients with AE of hepatitis B patients than those of MELD and MELD-Na.