Study On The Influencing Factors Of Chronic Acute Liver Failure In SAH Patients And The Therapeutic Effect Of Traditional Chinese Medicine

As a serious disease on the basis of alcoholic hepatitis and alcoholic cirrhosis,the clinical manifestations of Severe Alcoholic Hepatitis(SAH)are the rapid deepening of jaundice and coagulation failure.The onset of the disease is acute in a fierce condition treated difficultly.Glucocorticoid is a specific therapy for SAH,but it has no improvement on the long-term survival rate of the disease.Patients with SAH are at risk of acute-on-chronic liver failure(ACLF)driven by SIRS,with poor prognosis and difficult decline.How to identify advanced high-risk patients with ACLF after admission and actively take effective intervention,there is no reference to the results of previous studies.In order to provide important references for clinicians,the risk prediction model was established to explore the influencing factors of ACLF in patients with SAH.Chinese medicine is effective in the treatment of jaundice.For this reason,the study of the effect of traditional Chinese medicine on ACLF in patients with SAH can improve the patient's condition,prevent the progress of disease to ACLF,and provide more available therapeutic methods for clinicians.OBJECTIVE1.To explore the influencing factors of acute-on-chronic liver failure in patients with SAH,and to establish a PI model to predict the occurrence of acute-on-chronic liver failure.2.To investigate the effect of traditional Chinese medicine(TCM)combined with western medicine on the development of acute-on-chronic liver failure(ACLF)in patients with SAH.METHOD1.From August 2008 to October 2017,437 patients who were diagnosed as severe alcoholic hepatitis in Beijing Ditan Hospital Capital Medical University were collected in a retrospective method through the Electronic Medical Record system.The follow-up observation of patients with acute-on-chronic liver failure during hospitalization was carried out in this study.Further,COX regression analysis was applied to find out the influencing factors of the occurrence of acute-on-chronic liver failure.Besides,a PI model was established to predict the occurrence of acute-on-chronic liver failure during hospitalization in patients with SAH.2.From August 2008 to October 2017,437 patients who were diagnosed as severe alcoholic hepatitis in Beijing Ditan Hospital Capital Medical University were collected in a retrospective method through the Electronic Medical Record system.The patients were divided into Chinese medicine Group(95 cases)and non-Chinese medicine Group(163 cases).The Chinese medicine Group was analyzed by using Propensity Score Matching(PSM)to carry out the matching analysis,so as to compare the incidence of acute-on-chronic liver failure during hospitalization in two groups.RESULT1.The results of univariate and multivariate regression analysis of COX in 437 patients with SAH showed that TB,HDL,Cr,HGB and NLR were statistically significant in multivariate regression,among which TB,Cr and NLR were an independent risk factor for the development of acute-on-chronic liver failure in SAH patients.HDL and HGB were the independent protective factors of acute-on-chronic liver failure in patients with SAH.After that,the PI model was established.PI=0.382×LnNLR+0.800×LnCr+0.500×LnTB-0.374×LnHDL-1.527×LnHGB,The risk of acute-on-chronic liver failure was positively correlated with PI value.In addition,the area under ROC curve was 0.722 in predicting the occurrence of acute-on-chronic liver failure in patients with SAH during hospitalization by PI model,which was superior to CTP score,MDF score and MELD score model.According to Cut-off value,SAH patients were divided into high-risk group(PI?0.36)and low-risk group(PI<0.36).There was a significant difference in the incidence of acute-on-chronic liver failure between the two groups during hospitalization(53.6%vs 22.7%,P<0.001).2.The study also suggested that SAH patients with concurrent infection occupied a large proportion,and the common infections were abdominal infection,lung infection and fungal infection.There was a significant difference between SIRS groups on admission to the patients with ACLF.Further pairwise comparison of ACLF grades indicated that there were significant differences in ACLF1,2 and 3.SIRS,occurred in 19 cases(55.9%)of ACLF 3 patients on admission,was highest.The combination of SIRS on admission increased the risk of SAH progression to chronic and acute liver failure,and was associated with high-grade acute-on-chronic liver failure.3.According to the analysis of the application of Chinese medicine in 437 patients with SAH,95 cases of Chinese medicine group had the highest frequency of dampness-draining anti-icteric,followed by the medicine to promote blood circulation to remove blood stasis,in which the clearing away heat and toxic material is in a lowest application frequency.In Chinese medicine group,the most common used medicine was dampness-draining anti-icteric combined with the medicine to promote blood circulation to remove blood stasis.In addition,the baseline age,TB,HGB and Cr of 95 patients were matched at 1:1 by using the propensity score matching.90 patients in the Chinese medicine group were successfully matched.The results of Logistic univariate and multivariate regression analysis implied that NLR was an independent risk factor for SAH patients with acute-on-chronic liver failure during hospitalization,and HGB and Chinese medicine therapy were independent protective factors for its progress.In the further analysis of the organ failure about the matched Chinese medicine group and non-Chinese medicine group,the results showed that the incidence of cerebral dysfunction/failure in Chinese medicine group was 6.7%,which was lower than that of non-Chinese medicine group(16.7%).Therefore,the difference was statistically significant(P=0.037).CONCLUSION1.TB,HDL,Cr,HGB and NLR at baseline in patients with SAH are the independent influence factors for the progression of acute-on-chronic liver failure during hospitalization,among which TB,Cr and NLR are the independent risk factors for the development of acute-on-chronic liver failure in patients with SAH.Further,HDL and HGB are the independent protective factors of acute-on-chronic liver failure in patients with SAH.Furthermore,the PI model is established,PI=0.382 × LnNLR+0.800 × LnCr+0.500 ×LnTB-0.374×LnHDL-1.527×LnHGB.When the value of Cut-off is 0.36,the model has the maximum prediction efficiency.2.SAH patients complicated with infection accounts for a large proportion,and the common infections are abdominal infection,lung infection,and fungal infection.The combination of SIRS on admission increases the risk of SAH progression to acute-on-chronic liver failure,which is associated with high-grade acute-on-chronic liver failure.3.The types of Chinese medicine commonly applied in SAH patients are dampness-draining anti-icteric,the medicine to promote blood circulation to remove blood stasis,and the clearing away heat and toxic material.After matching the baseline of patients,it is found that NLR is an independent risk factor for acute-on-chronic liver failure in patients with SAH during hospitalization.HGB and Chinese medicine therapy are the independent protective factors for its progress.The study further concludes that Chinese medicine treatment can reduce the risk of brain dysfunction/failure in patients with SAH.