Establishment Of Nomogram To Evaluate 90-day Prognosis Of Acute-on-chronic Liver Failure

Object:To find independent factors affecting the 90-day prognosis of patients with acute-on-chronic liver failure(ACLF),and construct a nomogram to provide clinical reference for evaluating the 90-day prognosis of ACLF patients.Methods:The clinical data of 121 ACLF patients admitted to the Affiliated Hospital of Yanbian University from January 2012 to August 2021 were retrospectively collected and followed up for 90days.The outcomes were divided into survival group(n=47)and death group(n=74).Through the comparison of clinical data,independent influencing factors were screened out,nomogram was constructed,and its predictive value in the prognosis of ACLF patients was evaluated by comparing with the classical models.Results:1.Among the 121 patients with ACLF,52 case were hepatitis B(43%),33 case were alcoholic liver disease(27.3%),14 case were hepatitis C(11.6%),3 case were drug-induced liver disease(2.5%),6cases of hepatitis B complicated with alcoholic liver disease(5%),Cholestatic liver disease in 2cases(1.7%),Autoimmune liver disease in 2 cases(1.7%),2 cases of hepatitis B complicated with hepatitis C(1.7%),2 cases of hepatitis C complicated with alcoholic liver disease(1.7%),1case of hepatitis C complicated with cholestatic liver disease(0.8%),1 case of hepatitis B complicated with hepatitis C and alcoholic liver disease(0.8%),Unexplained liver disease in 3cases(2.5%).2.Age,WBC,K~+,LDH,CHE,TBil,Alb,BUN,Scr,PTA,INR,incidence of Hepatic encephalopathy(HE)and Spontaneous bacterial peritonitis(SBP)between survival and death groups were statistically significant differences among 12 factors(P<0.05).There was no significant difference between the two groups in 11 factors,including etiology,gender,RBC,Hb,PLT,NA~+,ALT,TBA,ascites,gastrointestinal bleeding,and respiratory failure(P>0.05).3.Logistic multivariate regression analysis showed that age,HE,K~+,LDH,TBil,Scr,and INR were independent risk factors for 90-day prognosis of ACLF patients(P<0.05).The older the age,the higher K~+,LDH,TBil,Scr,and INR,the worse the patient’s 90-day prognosis,and the patients who developed hepatic encephalopathy is worse than those who did not.4.The nomogram was established based on 7 independent risk factors.Compared with CTP and MELD AUC was 0.871,0.655,0.783;the sensitivity was 86.49%,74.32%,56.76%;the specificity was 78.71%,48.94%,89.36%,respectively.It indicated that the predictive value of nomogram in predicting the prognosis in ACLF patients at 90 days>MELD(P=0.0183)>CTP(P<0.001).Conclusion:1.The most common underlying cause of chronic liver disease in ACLF patients is hepatitis B-related liver disease,followed by alcoholic liver disease2.Age,HE,K~+,LDH,TBil,Scr,and INR were independent risk factors for 90-day prognosis of ACLF patients.3.The nomogram based on these 7 independent risk factors is superior to CTP and MELD in evaluating the 90-day prognostic value of ACLF patients.