Analysis Of Factors Influencing Short-term Prognosis Of HBV-ACLF Patients And Predictive Efficacy Of Combined MELD-LnAFP Score

Objective:To investigate the factors influencing the short-term prognosis of patients with chronic hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF),and to form a new score(MELD-Ln AFP)in combination with serum alpha-fetoprotein(AFP)and lactate dehydrogenase(LDH)and a commonly used model for end-stage liver disease(MELD)in clinical practice and analyze their predictive efficacy.Methods:The clinical data of 163 patients with HBV-ACLF who visited the Affiliated Hospital of Qingdao University and the Sixth People’s Hospital of Qingdao from September 2015 to December 2021 were collected and divided into survival group and death group according to the survival status of the study subjects at 90 days after admission.The general clinical data and biochemical data of the two groups were compared and analyzed to explore the related factors of HBV-ACLF patients’ prognosis.The prognostic factors(baseline serum AFP level,LDH level)of HBV-ACLF patients were combined with the commonly used clinical model(MELD score)to establish a new score.The prognosis(28 d and 90 d)of HBV-ACLF patients was predicted using baseline serum AFP level,LDH level and MELD score,respectively.The predictive ability of baseline serum AFP level,LDH level,MELD score and combined score was compared to explore the predictive score model with higher predictive ability.Results:1.A total of 163 patients with HBV-ACLF were included in this study.The ratio of survival to death was(133:30)and the mortality rate was 23% at 28 days after diagnosis.The ratio of survival to death was(117:46)and the mortality rate was 39.3% at 90 days after diagnosis.2.Gender and hepatic encephalopathy of HBV-ACLF patients,serum alanine/aspartate,total bilirubin,cholesterol,triglyceride,red blood cell count,hemoglobin,platelet count,lymphocyte count,ammonia,international normalized ratio,prothrombin activity,LDH,AFP,urea nitrogen,urea nitrogen/creatinine,neutrophil count/lymphocyte count,MELD score were significantly different between the two groups(P < 0.05),of which baseline serum AFP level,LDH level,MELD score were independent factors predicting the prognosis of HBV-ACLF patients at 90 days.3.When the baseline serum AFP level and MELD score were compared among patients with early,middle and late HBV-ACLF,there were significant differences in the prognosis between groups of patients with different stages.The baseline AFP level in the early group was significantly higher than that in the middle or late stage,and the MELD score in the late group was significantly higher than that in the early and middle stages.4.Baseline serum AFP level,MELD score and MELD-Ln AFP combined score were correlated with 28-day and 90-day prognosis of HBV-ACLF patients.The combined MELD-Ln AFP score had better predictive power than the MELD score and better predictive power at 28 days.5.Baseline serum LDH level is an independent risk factor for the prognosis of HBV-ACLF patients,and the survival of different LDH groups at 90 days is significantly different,but its predictive power for predicting the prognosis of patients at 28 days and90 days is poor,and it cannot significantly improve the predictive power of MELD score after combined with MELD score.Conclusion:1.The mortality rate of HBV-ACLF patients at 90 days after diagnosis can be as high as 39.3%.2.Serum baseline AFP level is an independent protective factor for short-term prognosis in HBV-ACLF patients,and serum baseline LDH level and MELD score are independent risk factors.3.The serum baseline AFP level in the early HBV-ACLF patient group was significantly higher than that in the middle or late groups,and the MELD score in the late group was significantly higher than that in the early and middle groups.4.Baseline serum AFP level,MELD score and MELD-Ln AFP combined score are closely related to the short-term prognosis of HBV-ACLF patients,and the combined score has better predictive efficacy.5.Serum baseline LDH level and MELD-Ln LDH combined score have poor ability in predicting the short-term prognosis of HBV-ACLF patients.