Analysis Of Prognostic Risky Factors For Acute-on-Chronic Liver Failure

Objective:To analyze the prognostic related factors for patients with acute-on-chronic liver failure and to find the independent risk factors for short-term prognosis of patients with ACLF.To compare the predictive value of CTP,MELD,ALBI,ABIC scoring models in the 28-day mortality of patients with ACLF.To provide an evidence for the prognosis of patients with ACLF.Methods:It is a retrospective study.To collect the clinical data of 168 patients with ACLF admitted to The Second Hospital of Dalian Medical University from March 1,2010 to November 1,2019.All patients were divided into survival group（n=61）and death group（n=107）in regard to their 28-day survival after their admission.The clinical data of the two groups were compared,and the significant single factor was further analyzed by logistic multivariate regression analysis to find independent risk factors which affected prognosis.The CTP score,MELD score,ALBI score and ABIC score were calculated in two groups.To compare the predictive value of the four models in the 28-day mortality of patients with ACLF by using the receiver operating characteristic（ROC）curve and to get the cut-off value by using the Youden index.Results:1.There were statistically significant differences between the survival group and the death group in age,white blood cell（WBC）,absolute neutrophil count,neutrophil-lymphocyte ratio（NLR）,platelet to white blood cell ratio（PWR）,prothrombin time（PT）,prothrombin time activity（PTA）,prothrombin time-international normalized ratio（PT-INR）,aspartate aminotransferase（AST）,total bilirubin（TBil）,total bile acid（TBA）,lactate dehydrogenase（LDH）,blood urea nitrogen（BUN）,serum creatinine（SCr）,potassium（K⁺）,sodium（Na⁺）,chlorion（Cl^-）,phosphonium(P³⁺),magnesium(Mg²⁺),blood ammonia（NH₃）,hepatic encephalopathy（HE）,upper gastrointestinal hemorrhage and hepatorenal syndrome（HRS）.There were no statistically difference between the survival group and the death group in gender,absolute lymphocyte count,red blood cell（RBC）,hemoglobin（HGB）,platelet（PLT）,alanine aminotransferase（ALT）,albumin（Alb）,gamma-glutamyltransferase（GGT）,alkaline phosphatase（ALP）,calcium(Ca²⁺),glucose（Glu）,ascites,spontaneous bacterial peritonitis（SBP）and other infection.2.The value of CTP,MELD,ALBI,ABIC score were significantly higher in death group than in survival group.3.The logistic multivariate regression analysis indicated that age,total bilirubin（TBil）,ammonia（NH₃）and hepatorenal syndrome（HRS）were the independent risk factors of short-term prognosis of patients with ACLF.4.The area under the ROC curve（AUC）:MELD score（AUC=0.838）>ABIC score（AUC=0.791）>CTP score（AUC=0.681）>ALBI score（AUC=0.630）.The cut-off value of MELD score was 27.01,its sensitivity and specificity were 0.589 and 0.951.The cut-off value of ABIC score was 9.53,its sensitivity and specificity were 0.598 and 0.885.The cut-off value of CTP score was 13.50,its sensitivity and specificity were 0.449 and0.852.The cut-off value of ALBI score was-0.70,its sensitivity and specificity were0.533 and 0.738.Conclusion:1.There were statistically significant differences between the survival group and the death group in age,white blood cell（WBC）,absolute neutrophil count,neutrophil-lymphocyte ratio（NLR）,platelet to white blood cell ratio（PWR）,prothrombin time（PT）,prothrombin time activity（PTA）,prothrombin time-international normalized ratio（PT-INR）,aspartate aminotransferase（AST）,total bilirubin（TBil）,total bile acid（TBA）,lactate dehydrogenase（LDH）,blood urea nitrogen（BUN）,serum creatinine（SCr）,potassium（K⁺）,sodium（Na⁺）,chlorion（Cl^-）,phosphonium(P³⁺),magnesium(Mg²⁺),blood ammonia（NH₃）,hepatic encephalopathy（HE）,upper gastrointestinal hemorrhage and hepatorenal syndrome（HRS）.2.Older age,higher TBil,higher NH₃ and hepatorenal syndrome（HRS）were independent risk factors for short-term prognosis of patients with ACLF.3.The predictive value of CTP,MELD,ALBI,ABIC scoring models in the 28-day mortality of patients with ACLF was MELD score>ABIC score>CTP score>ALBI score.The ABIC score has the highest sensitivity and the patients with ABIC score≥9.53 has higher risk for short-term mortality.