Predictive Value Of Liver Function Scoring Model In Patients With Alcoholic Liver Disease Associated With Chronic Acute Liver Failure And Clinical Analysis Of Young Patients

objective:To explore the risk factors affecting the 90-day prognosis of patients with alcoholic hepatopathy associated chronic acute liver failure(ALD-ACLF),compare the predictive efficacy of ALBI score,MELD score,Meld-NA score,i MELD score,MESO score and PALBI score,and then compare the clinical characteristics of the young group and the middle-aged and elderly group.The different clinical characteristics between the two groups were analyzed in order to provide reference for the selection of clinical treatment,improve the quality of medical treatment and save medical resources.Methods:A total of 119 patients diagnosed with ALD ACLF for the first time in the First Affiliated Hospital of Dali University from January 2013 to June 2022 were collected,and their first laboratory test data were collected.The patients were divided into the death group(52 patients)and the survival group(67 patients)according to their 90-day survival,and the youth group(32 patients)according to their age ≤44 years old.> 44 years old group(87 persons).spss statistical software was used to compare the differences between the survival group and the death group in general demographic characteristics,laboratory examination data,complications,organ failure and scoring model scores,and to find the risk factors affecting the short-term(90 days)prognosis of patients in the ALD-ACLF group.Medcalc statistical software was used to compare the predictive efficacy of ALBI score,MELD score,Meld-NA score,i MELD score,MESO score and PALBI score model.The working characteristic curve of subjects was drawn and the area under the curve was compared to determine the specificity,sensitivity,Joden index and clinical truncation value of different score models.To evaluate the predictive value of the optimal cut-off value for patient death.Finally,the clinical characteristics of young patients were analyzed compared with the middle-aged and elderly group.Results:1.Comparison of general information,complications and organ failure between the survival group and the death group: A total of 119 patients were included in the study,including 67 patients in the survival group and 52 patients in the death group,with a mortality rate of 43.69%.There were no significant differences in gender,age,body mass index,drinking years,pulmonary infection,peritonitis and hepatic encephalopathy between the survival group and the death group.The incidence of ascites,liver failure,renal failure and coagulation failure in death group was higher than that in survival group(P>0.05),and the difference was statistically significant(P<0.05).2.Comparison of laboratory indexes between survival group and death group:TBIL,PT,In R,NLR and MLR in death group were higher than those in survival group,and the difference was statistically significant(P<0.05);There was no significant difference between ALT、AST、FIB、ALB、Cr、BUN、K、Na、WBC、RBC、NEUT、LYMP、MONO、RDW、PLT、AFP、PLR and PWR groups(P>0.05).Multivariate Logistic regression analysis showed that TBIL was an independent risk factor affecting the prognosis of patients.3.ALBI score,MELD score,Meld-NA score,i MELD score,MESO score and PALBI score of the death group were higher than those of the survival group,and the difference was statistically significant.The AUCs of the six models were compared,Meld-Na score > MESO score >MELD score > i MELD score > PALBI score > ALBI score.4.The clinical cut-off values of ALBI score,MELD score,Meld-NA score,i MELD score,MESO score and PALBI score were-0.4、20.87、41.35、22、1.56 and-0.78,respectively,and the mortality rate of patients with scores higher than the clinical cut-off value was higher.5.Comparison between youth group and middle-aged and elderly group: There were 32 patients in the young group(26.89%)and 87 patients in the middle and old group(73.10%).There were no significant differences in mortality,gender,body mass index,drinking years,pulmonary infection,peritonitis,hepatic encephalopathy,ascites,liver failure,renal failure and coagulation incidence between the two groups(P > 0.05).The Cr,BUN and RBC of the young group were significantly lower than those of the middle and old group,while the WBC,NEUT,LYMP,MONO and PLT of the young group were significantly higher than those of the middle and old group,the difference was statistically significant.There was no significant difference in TBIL、PT、In R、ALT、AST、FIB、ALB、K、Na、RDW、AFP、NLR、MLR、PLR and PWR between the two groups(P > 0.05).Conclusion:The 90-day mortality rate of patients with alcohol-related chronic acute liver failure was 43.69%.TBIL was an independent risk factor for predicting death.ALBI score,MELD score,Meld-NA score,i MELD score,MESO score and PALBI score all had certain predictive value for death of patients.MELD-Na score had the best predictive value,and the best truncation value of the six scoring models also had predictive value in predicting patient death.Among the patients included in the study,the youth group accounted for 26.89%.Compared with the middle-aged and elderly group,there was no statistical difference in the incidence of mortality,complications and organ failure in the youth group.