Value Of Charlson Comorbidity Index In Predicting The Prognosis Of Patients With Acute-on-chronic Liver Failure

Background and Objective: Both the Charlson Comorbidity Index(CCI)and the age-adjusted Charlson Comorbidity Index(ACCI)are commonly used comorbidity evaluation tools to assess patient prognosis.Patients with acute-on-chronic liver failure(ACLF)often have more than one comorbidity and have high short-term mortality,but the effect of comorbidity burden on the prognosis of patients with ACLF has not been evaluated.The purpose of this study was to explore the influence of comorbidity on the prognosis of patients with ACLF and its evaluation value through CCI and ACCI,in order to provide new indicators for the complex clinical prognosis evaluation of ACLF.Methods: According to the inclusion and exclusion criteria,422 patients with ACLF admitted to the First Hospital of Lanzhou University from December 2016 to December 2021 were strictly screened,and 317 patients with ACLF meeting the criteria were finally included as research objects.Baseline clinical data of patients were obtained,and patients were followed up and follow-up data was obtained.Patients were divided into poor prognosis group and good prognosis group according to their prognosis outcome.T test and Mann-Whitney U test were used to compare the difference of baseline data between the two groups.Logistic regression and Cox regression were used to analyze the influencing factors of prognosis in patients with ACLF.Kaplan-Meier survival curve was plotted,and receiver operating characteristic curve(ROC)was used to evaluate the prognostic efficacy of influencing factors in the prognosis of patients with ACLF.Results:1.Comorbidities distribution of patients: The comorbidities of ACLF patients are mainly distributed in moderate and severe liver disease,moderate and severe kidney disease,chronic lung disease,solid tumor,diabetes mellitus with chronic complications,peptic ulcer and congestive heart failure.The ages of ACLF patients are mainly distributed in [18,50)years old and [50,60)years old.2.Baseline characteristics of patients: A total of 317 ACLF patients meeting the criteria were included,including 169 patients in the poor prognosis group and 148 patients in the good prognosis group.The comparison of baseline characteristics between the two groups showed that age,D-dimer(D-D),model of end-stage liver disease(MELD)score,CCI and ACCI in the poor prognosis group were significantly higher than those in the good prognosis group(all P<0.05).3.Correlation analysis of survival time of patients with poor prognosis: There was a positive correlation between prothrombin activity(PTA)and the survival time of ACLF patients.There was a strong negative correlation between CCI(r=-0.519,P<0.001)、ACCI(r=-0.543,P<0.001)and survival time of ACLF patients.4.Influencing factors and predictive value of prognostic outcome in ACLF patients: CCI(OR=2.702,95%CI 2.019-3.617,P=0.002),ACCI(OR=2.414,95%CI1.840-3.167,P<0.001),MELD score(OR=1.153,95%CI 1.082-1.229,P<0.001),D-D(OR=1.161,95%CI 1.050-1.282,P=0.003)and activated partial thromboplastin time(APTT)(OR=1.040,95%CI 1.013-1.069,P=0.004)were independent risk factors for adverse prognostic outcome in ACLF patients.The area under ROC curve(AUC)of CCI,ACCI,MELD score and D-D were all greater than 0.7,among which CCI had the best predictive effect on prognostic outcome(AUC=0.845,P<0.001).5.Comparison of cumulative survival rate of ACLF patients with different CCI or ACCI: With the increase of CCI or ACCI,the case fatality rate of ACLF patients showed an increasing trend.With the extension of time,the cumulative survival rate of ACLF patients showed a downward trend.There were significant differences in the cumulative survival rate at different time nodes among the three groups regardless of CCI or ACCI grouping(P<0.05).6.Analysis of factors influencing the overall survival of ACLF patients:CCI(CCI≥5 vs CCI≤4: HR=5.039,95%CI 3.362-7.553,P<0.001),ACCI(ACCI≥5 vs ACCI≤4: HR=4.845,95%CI 3.043-7.715,P<0.001),MELD score(MELD≥25.34 vs MELD<25.34: HR=2.591,95%CI 1.831-3.666,P<0.001)and D-D(D-D≥1.85mg/L vs D-D<1.85mg/L: HR=5.039,95%CI 3.362-7.553,P<0.001)were independent risk factors for overall survival in patients with ACLF.Conclusion: As CCI or ACCI scores increase,the risk of poor prognostic outcomes increases and overall survival decreases in ACLF patients.At the same time,CCI and ACCI have a certain value in predicting the adverse prognosis of patients with ACLF.Stratified management of ACLF patients according to CCI or ACCI score is of great significance in guiding individual treatment of patients.