Study On The Liver To Abdominal Area Ratio In Predicting The Risk Of Hepatocellular Carcinoma In Patients With Prior History Of Acute On Chronic Liver Failure

Background & Aims: To explore the predictive value of the liver to abdominal area ratio(LAAR)in for hepatocellular carcinoma(HCC)in patients with hepatitis B virus-(HBV)related acute on chronic liver failure(ACLF).Methods: This study retrospectively included HBV-ACLF patients admitted to the First Affiliated Hospital of Fujian Medical University from 2014 to 2017.Patients were followed up for the occurene of HCC.Baseline characteristics of these two groups were compared using student’s t-test or Mann-Whitney test.Univariate and multivariable COX proportional hazard analysis were used to identify independent risk factors for HCC.The best predictive value of LAAR was determined by the sensitivity and specificity of receiver-operating characteristic curve(AUC).Results: A total of 109 patients with HBV-ACLF were included in this study.The average age was 45.13±14.19 years old,and 87(79.82%)were males.There were 6patients developed HCC and 8 patients died during the 47.7 months of follow-up.According to the occurrence of HCC,the patients were divided into HCC group(n =6)and non-HCC group(n = 103).There were significant differences in HBs Ag and LAAR between the two groups.On the cox regression analysis,LAAR(HR 0.835;95%CI 0.699-0.997)were independent risk factors for HCC.The area under the curve of LAAR for predicting HCC was 0.788(0.640-0.936).The optimal cut-off value of LAAR for predicting HCC was 41.35,and the sensitivity and specificity are 74.8%and 83.3%,respectively.Kaplan-Meier Analysis showed the incidence of HCC was significantly increased in patients with LAAR < 41.35(P < 0.009).There were significant differences in cirrhosis,MELD score and s Cr between the two groups.On the cox regression analysis,s Cr(HR: 1.015;95% CI: 1.001-1.030)were independent risk factors for death.Conclusions: 1.The LAAR is an independent risk factor for HCC in patients with HBV-ACLF.2.The threshold of LAAR for predicting HCC is 41.35.3.The LAAR is not an independent risk factor for death in patients with HBV-ACLF.