Predicting The Prognostic Value For Hepatic Failure Treated With Artificial Liver Support System By MELD And CTP Score Systems

Objective: To asess and predict the prognostic value for hepatic failure treated with artificial liver support system (ALSS) by model for ends-tage liver disease and Child-Turcotte-Pugh score systems.Method: Methods: 210 Patients with liver failure in hospital were divided into 115 cases of artificial liver support system (ALSS) treatment group and 95 cases of control group. respectively, two groups were scored by MELD and CTP score systems; two groups were observed and assessed changes in biochemical, coagulation parameters and MELD score before and after treatment; The short-term survival rate between two groups was evaluated and compared by means of MELD and CTP score systems, while the short-term survival rate and survival time different MELD scores was analyzed and compared by application of Kaplan-Meier (K-M) survival curve between two groups.results: Results: The levels of total bilirubin, INR of patients was lower than that before ALSS treatment, showing significant difference between before and after ALSS (p<0.05). Plasma albumin level of patients was higher than before ALSS treatment, whose MELD scores were 20～30, showing statistically significance (p<0.05). PTA level of patients was higher than before ALSS treatment, whose MELD scores were less than 20, 20～30 and 30～40, showing significant difference(p<0.01).Except the subgroupwith MELD score higher than 40, MELD scores in other three subgroups were lower than that before ALSS treatment, showing significant difference(p<0.01); there is difference between△MELD of the ALSS treatment group and that of the control group(p<0.01 or p<0.05)).The scores of MELD had positive correlation with the actual mortality rate.Among MELD scores were 20～30 and 30～40, the mortality rate of patients in ALSS treatment group (respectively, 40.8% and 55.3%) was lower than expected mortality rate (respectively, 76% and 83%), there was a significant difference between two groups (p<0.01); but It was lower than mortality rate of the control group (respectively, 61.9% and 84.4%), there is difference between the two groups(p<0.05);The mortality rate of patients in the ALSS treatment group and the control group gradually increased in CTPC scoring group, following MELD scores to raise. There were difference among the mortality of patients of CTPC scores group following MELD scores to increase (the treatment groupⅩ~2 = 6.54, p<0.05, the control groupⅩ~2 = 17.92, p<0.01); The mortality of patients of CTPC scoring groups in the control group were higher than in that of the ALSS treatment group, whose MELD scores were 20～30 and 30～40, there were difference between the two groups (respectively,Ⅹ~2 = 3.90, p<0.05 andⅩ~2 = 4.40, p<0.05); Hower, the mortality of patients was 90% in the ALSS treatment group and 100% in the control group whose MELD scores all were higher than 40, showing no significant difference between the two groups(p>0.05). It was showed that the survival time and short-term survival rate of patients with differen MELD scores were higher in the ALSS treatment group than in the control group according to Kaplan-Meier(K-M) survival curvewhose MELD scores were 20～30 and 30～40. There is significant difference between the two groups (Log-Rank test, respectivelyⅩ~2 = 3.89, p <0.05,Ⅹ~2= 5.70, p <0.05).Conclusions: The biochemical parameters and inter environment can be significantly improved in patients with liver failure by ALSS treatment, thus the treatment can delay the further development of liver failure. The patients with liver failure were treated by ALSS as possible if the thepathogenetic conditions of them permit. Therapeutic effect of the patients was better with ALSS treatmen than with medical treatment, whose MELD scores were 20～30 and 30～40, especially the patients (CTP C level) were treated by ALSS as possible early. It may be a better therapeutic effect if the treatment of patients should be repeated many times by ALSS . MELD and CTP score systems are useful in predicting the therapeutic effectiveness of ALSS on hepatic failure. These two kinds of scoring systems can increase accuracy of prediction.