Application Of Serum Alpha Fetoprotein And Prothrombin Time Activity In Predicting Prognosis Of Patients With Acute-on-chronic Liver Failure

BackgroundAcute-on-chronic liver failure(ACLF)is one of the most common types of liver failure,which is classified by the pathological characteristics of the liver and the development of the disease.The prognosis of ACLF is generally poor,and liver transplantation is an effective means to cure all kinds of end-stage liver disease and save the patient's life.It is important to guild clinical treatment of ACLF with the early and accurate prognosis,so as to help physicians to diagnose and treat the disease correctly and quickly.Clinically,there are many indexes to judge the prognosis of ACLF.Both alpha fetoprotein(AFP)and prothrombin time activity(PTA)is used to judge the prognosis of ACLF,which is reported largely at home and abroad,but the joint report of PTA and ACLF is quite few.ObjectiveTo evaluate the clinical value of AFP with PTA in ACLF.MethodsTo retrospective analyze 95 patients,who met the ACLF diagnostic criteria,from January 2013 to 2016 in Nanyang Central Hospital.The patients were divided into improved group(49 cases)and ineffective group(46 cases).The data of caseswere used to construct a database by Microsoft Excel 2010 software,and analyzed by SPSS 17 software.Chi-square test was used to analyze qualitative data and Student's test to quantitative data.Meanwhile,the significance factors were deeply studied by Logistic regression analysis and filtered out the independent risk factors,which were related to the prognosis of ACLF.To compare the fluctuated differences between AFP and PTA(before and after treatment)of two groups and the levels of AFP and PTA of two groups respectively.To use the area under the cure(AUC)of receiver operating characteristic(ROC)to evaluate the prognostic value of AFP and PTA of ACLF.Results1.The single factor analysis showed the age,prothrombin time(PT),PTA,total bilirubin(TBIL),albumin(ALB),AFP were the factors which significantly influenced the prognosis of ACLF(P < 0.05).2.The independent risk factors of prognosis of patients of ACLF were filtered out and analyzed by multivariate Logistic regression analysis.The PTA and AFP were the facts which significantly influence the prognosis of ACLF(P < 0.01).3.The AFP and PTA of improvement group were significantly higher than those of the ineffective group respectively(P<0.01).At different levels of AFP and PTA,there were significant differences on the incidence rate of the two groups(P<0.01).The ROC of researchers showed that the AUC was 0.989,the sensitivity was 91.8%,the specificity was 100%,accomplished with a combined AFP?80.025?g/Land PTA?32.100% way to predict the outcome of ACLF.Conclusion1.The more severe necrosis of liver cells,the lower the level of AFP,the level of AFP were positively correlation with the degree of liver cell necrosis,and they could be the independent predictors.The more severe necrosis of liver cells,the more obvious the decrease of PTA,the decrease of PTA was positively correlated with the severity of liver cell necrosis,and they could be the independent predictors.2.Serum AFP and plasma PTA were important prognostic factors to predict the prognosis of ACLF,and the prognosis of ACLF could be predicted more accurately by combining AFP with PTA,which was more specificity.