Analysis Of Factors Influencing The Short-term Outcome And Prognosis Of Patients With Liver Failure Treated With Artificial Liver Support System

Background and purpose: Liver failure is characterized by rapid disease progression,difficulty in treatment and a high mortality rate.One method of treating liver failure is the artificial liver support system(ALSS),which restores liver function temporarily while maintaining the internal environment and fostering the growth of liver cells.However,the treatment modalities and prediction of the efficacy of ALSS remain an unanswered question,and the factors affecting the efficacy and prognosis of patients with liver failure treated with ALSS need to be explored in depth for clarity.Therefore,this study investigates the efficacy of ALSS,the rate of reduction in total bilirubin(TBil)and short-term clinical outcomes,with the aim of investigating the factors influencing the efficacy and prognosis of patients with liver failure treated with ALSS.Methods: Patients with liver failure who were hospitalized at the First Hospital of Lanzhou University from January 2019 to June 2022 and receiving ALSS were screened,and 148 patients were finally included as study subjects according to the inclusion and exclusion criteria.The liver failure group is distinguished into the hepatitis B virus(HBV)-related liver failure group and the non-HBV-related liver failure group according to the cause of liver failure,and the factors influencing the efficacy of ALSS in different etiologies were obtained through univariate and multifactorial analysis.Factors influencing the reduction rate of TBil at different stages of treatment were obtained through univariate and multifactorial analysis by dividing the reduction rate of TBil into two groups: <50% and ≥50%.Finally,patients were graded into fatality and survival groups according to their survival endpoint 90 days after discharge from the hospital,and factors influencing ALSS therapy on 90-day survival in patients with liver failure obtained by Cox regression analysis.Receiver operating characteristic(ROC)analysis is used to evaluate the accuracy of PTAR and NLR in predicting various outcomes for ALSS-treated patients with liver failure.Results:1.Analysis of short-term effectiveness of ALSS in patients with liver failure of different etiologies:(1)Compared with the non-HBV liver failure group,HBV failure group had a higher proportion of male and cirrhotic patients,higher levels of blood urea nitrogen,serum creatinine and NLR,and a shorter interval between ALSS(P<0.05);while the proportion of patients with combined hepatic encephalopathy was lower,and the levels of glutamyl transpeptidase and triglycerides(TG)were lower(P<0.05).(2)In the analysis of the efficacy of HBV liver failure,multi-factor logistic analysis revealed that NLR(OR=0.884,95%CI:0.784～0.986)was an independent risk factor affecting the efficacy of treatment after ALSS in patients with HBV liver failure.(3)In the analysis of the efficacy of non-HBV failure group,multi-factor logistic analysis revealed that TG(OR=2.555,95%CI:1.108～6.413)was an independent risk factor affecting treatment efficacy after ALSS in patients with non-HBV liver failure.2.Analysis of the rate of decline in TBil at different stages in patients with liver failure treated with ALSS:(1)At the mid-stage of artificial liver treatment,multi-factor logistic analysis demonstrated that PTAR(OR=0.861,95%CI:0.750～0.988)was an independent influencing factor for the rate of TBil decline≥50% at the mid-stage of ALSS(P<0.05).(2)At the termination of artificial liver treatment,multi-factor logistic analysis demonstrated that TG(OR=1.754,95%CI:1.019～3.020)and PTAR(OR=0.770,95%CI:0.637～0.930)were independent influencing factors for TBil≥50% at the end of ALSS(P<0.05).3.Analysis of different clinical endpoints in patients with liver failure treated with ALSS:(1)Cox regression analysis demonstrated that age(HR=1.037,95%CI:1.009～1.065),NLR(HR=1.038,95%CI:1.019～1.058),and PTAR(HR=1.121,95%CI:1.007～1.247)were independent factors influencing 90-day death in patients withliver failure after ALSS.(2)Analysis of the predictive value of PTAR and NLR on end results revealed that the AUC of PTAR for determining the prognosis of patients with liver failure at baseline,after first ALSS,after second ALSS and the end of treatment were respectively 0.679,0.671,0.755 and 0.851;the AUC of NLR for determining the prognosis of patients with liver failure at baseline,after first ALSS and the end of all treatment were 0.681,0.699,0.808,respectively.The AUC for the combination of PTAR and NLR were 0.755,0.847 and 0.865 for the prognosis of patients at baseline,after first ALSS and at the end of all treatments,respectively.Conclusions:1.For patients with HBV liver failure receiving ALSS,NLR was an independent influencing indicator for the therapeutic efficacy of ALSS.The higher neutrophil count and the lower lymphocyte count,the weaker benefit of ALSS,while for patients with non-HBV liver failure,the better the outcome of patients treated with ALSS when their TG levels were higher.2.PTAR was an independent factor in the short-term reduction of TBil in patients with liver failure treated with ALSS,and the rate of short-term reduction of TBil was lower in patients with liver failure with higher PT-INR and lower ALB.3.Pretreatment PTAR and NLR are independent risk markers with good independent predictive value for the 90-day prognosis of patients with liver failure treated with ALSS;the two combinations have a higher predictive value for the shortterm prognosis of patients with liver failure while undergoing ALSS.