Analysis Of Factors Affecting Short-term Prognosis Of Patients With Hepatitis B Related Acute On Chronic Liver Failure And The Effect Of Different Types Of Artificial Liver On The Prognosis Of Patients

Objective:To investigate the short-term prognostic factors in patients with acute on chronic liver failure related with hepatitis B(HBV-ACLF)and the effect of different types of artificial liver models on the prognosis.Methods:The retrospective analysis method,according to the diagnostic criteria of the guidelines for the diagnosis and treatment of liver failure,138 patients with HBV-ACLF admitted to the infection department of the second affiliated hospital of Nanchang university from June 2016 to June 2018 were selected as the objects of observation by retrospective analysis.All patients were routinely treated with comprehensive internal medicine during their hospitalization,and 117 received artificial liver therapy.The patients were divided into survival/improvement group(n=86 cases)and death/deterioration group(n=52 cases)according to the prognosis of the 3-month follow-up.The clinical data of the patients were recorded as follows:(propagated)gender,age,ALBumin,total bilirubin(TBIL),aspartate aminotransferase(AST),glutamic acid transaminase(ALT),prothrombin time international standardization ratio(INR),prothrombin activity(PTA),triglyceride(TG)and hepatic encephalopathy(HE),a tire protein(AFP),total bile acid(associates),cholinesterase(CHE),platelet(PLT),neutrophil percentage(N %),and hepatitis b virus DNA(HBV DNA),three quantitative iodine thyroid glycine(T3),thyroxine(T4),grease Multivariate logistic regression analysis was performed to analyze the factors affecting the short-term prognosis of patients with environmental enzyme,amylase,blood ammonia,upper gastrointestinal bleeding,primary peritonitis and ascites,and the effects of different artificial liver models on the short-term prognosis of patients with liver failure were compared.Results:The TBIL,INR,MELD amylase and lipase of 52 patients in the death/deterioration group were significantly higher than those in the survival/improvement group(P < 0.05).At admission,ALB,CHE,PTA%,PLT,T3 and TG in the death/deterioration group were significantly lower than those in the survival/improvement group(P < 0.05).The incidence rates of hepatic encephalopathy,spontaneous peritonitis and gastrointestinal bleeding in the two groups were compared,and the differences were statistically significant(P < 0.05).2.The incidence of hepatic encephalopathy,gastrointestinal bleeding and spontaneous peritonitis was compared between the two groups,and the difference was statistically significant(P < 0.05).3.Multivariate Logistic regression analysis indicated that older age,higher MELD score,higher INR,lower T3,lower TG,and lower PLT were independent risk factors affecting short-term prognosis of HBV-ACLF,and high ALB[OR(95%ci)=0.874(0.799,0.956),P < 0.001] could be used as protective factors for short-term prognosis of HBV-ACLF patients.4.The optimal cut-off values of MELD and INR for predicting short-term mortality risk of HBV-ACLF patients were 23.5,1.34,71.2%,92.3%,68.6% and 40.7%,respectively.5.The ratio of INR to T3 was 0.783,higher than MELD score(0.760)and INR(0.760),and the ratio sensitivity of INR to T3(96.2%)was significantly higher than MELD score,suggesting that the use of INR to T3 has a better prediction ability for short-term mortality in HBV-ACLF patients than MELD score.6.At the same time,the ratio of INR to TG and ALB was used in this study to predict short-term mortality of patients with HBV-ACLF,and the results indicated that both of them had good predictive value,with an AUC of 0.732 and 0.753,respectively.Are highly statistically significant differences(P < 0.01)will also attempt to MELD score joint selected risk factors such as PLT,TG,T3,propagated joint or take the ratio of the two,such as the MELD + PLT,MELD + TG,MELD + T3,MELD + propagated,MELD/PLT,MELD/propagated,through joint of different indicators to further improve the short-term survival rate in patients with HBV-ACLF predictive value,AUC were 0.385,0.745,0.744,0.613,0.712,0.759,The results indicated that MELD combined with other indicators had certain predictive value,but all of them were lower than the predictive value of MELD score alone(0.760).7.After the treatment of HBV-ACLF patients with different modes of artificial liver PP(bilirubin adsorption),PDF(plasma dialysis filtration),PP+PDF(bilirubin adsorption + plasma dialysis filtration),TBil,MELD,INR,PTA,Cr,ALB,ALT,AST,AFP,CHE,N,PLT were compared.The results indicated that TBi L,N% decreased and PTA increased,and the difference between PP group and PDF group after treatment was statistically significant(P < 0.05),while the difference between PP+PDF group was not statistically significant(P > 0.05).The values of MELD score,ALT and AST in the three groups all decreased significantly after treatment,and the differences before and after treatment were statistically significant(P < 0.05).There was statistically significant difference in AFP before and after treatment in PP group and PP+PDF group(P < 0.05),but no statistically significant difference before and after treatment in PDF group(P > 0.05).In addition,TBil,INR,MELD,PTA and ALB of the three groups were compared before and after treatment,and the differences were not statistically significant(P = > 0.05).The survival rate of HBV-ACLF treated with different artificial liver modes showed no significant difference among the three groups(P < 0.05).Compared with the control group,there was no significant difference in 12-week survival rate among the three groups(P > 0.05).Conclusions:Older age,higher INR and MELD,and lower T3,TG and PLT are independent risk factors for short-term prognosis of HBV-ACLF patients.Elevated ALB can be used as a protective factor for short-term prognosis of HBV-ACLF patients.The use of INR/T3 ratio to predict short-term death risk of HBV-ACLF patients has a good clinical predictive value;Early and active prevention of complications is crucial in the diagnosis and treatment of HBV-ACLF patients.Different artificial liver models have better effects on improving the coagulation function and liver function of patients,but have no effect on the short-term prognosis of HBV-ACLF patients.