| Objectives:To compare the value of three diagnostic criteria for ACLF proposed by the European Society of Hepatology(EASL),the Asia Pacific Society of Hepatology(APASL),and the Chinese Medical Association(CMA)in predicting the prognosis of patients with ACLF on days 7,28,and 90;Compare the differences in clinical characteristics and prognosis of patients with ACLF defined by the three diagnostic criteria for EASL,APASL,and CMA.Methods:This study used a retrospective cohort study to analyze the clinical data of 337 patients with ACLF who were hospitalized in the Department of Gastroenterology,the Second Affiliated Hospital of Kunming Medical University from January 2020 to September 2022.This study used a retrospective cohort study to analyze the clinical data of 337 patients with ACLF who were hospitalized in the Department of Gastroenterology,the Second Affiliated Hospital of Kunming Medical University from January 2020 to September 2022.According to the three diagnostic criteria of EASL,APASL and CMA,the enrolled patients were divided into three groups.The APASL group met the diagnostic criteria for ACLF set by APASL at baseline,and the EASL group met the diagnostic criteria for ACLF set by EASL at baseline,The CMA group met the diagnostic criteria for ACLF established by CMA at baseline.The general information,etiology of chronic liver disease,basis of chronic liver disease,acute triggering factors,laboratory indicators and clinical complications,incidence of organ failure,and differences in survival rates on day 7,28,and 90 were compared among the three groups of patients.The clinical characteristics and prognosis of the three groups of ACLF patients were analyzed;Evaluate the predictive value of three diagnostic criteria in predicting 7-day,28-day,and 90-day mortality rates in patients with ACLF.Results:1.A total of 337 patients with ACLF were included in this study,including 182patients(54.0%)in the APASL group,99 patients(29.4%)in the EASL group,and 211patients(62.6%)in the CMA group.Among them,71 ACLF patients met both CMA and APASL diagnostic criteria(21.1%),37 ACLF patients met both CMA and EASL diagnostic criteria(11.0%),5 ACLF patients met both APASL and EASL diagnostic criteria(1.5%),and 21 ACLF patients met all APASL,EASL,and CMA diagnostic criteria(6.2%).2.The main cause of chronic liver disease among enrolled ACLF patients was HBV infection(35.3%),followed by alcoholic liver disease(21.7%);The main basis of chronic liver disease is cirrhosis(91.1%),and the main acute inducing factor is bacterial infection(57.3%);The most common complication is ascites(79.0%),and organ failure analysis shows that liver failure is the most common(51.6%),followed by coagulation failure(19.6%).3.Comparative analysis of the general data,etiology,and basis of chronic liver disease in patients with ACLF in APASL,EASL,and CMA groups: Comparative analysis of general information,chronic liver disease etiology,and chronic liver disease basis of three groups of ACLF patients: APASL,EASL,and CMA: The proportion of HBV infection in the etiology of chronic liver disease in APASL group and CMA group patients is significantly higher than that in EASL group(P<0.05);The proportion of non cirrhotic patients to compensated patients in the APASL group and CMA group was significantly higher than that in the EASL group,and the proportion of compensated patients in the APASL group was significantly higher than that in the CMA group(P<0.05);The proportion of decompensated liver cirrhosis patients in the EASL and CMA groups was significantly higher than that in the APASL group,and the proportion of decompensated liver cirrhosis patients in the EASL group was significantly higher than that in the CMA group(P<0.05).4.Comparison of acute predisposing factors,clinical complications,and MELD scores among patients with ACLF in APASL,EASL,and CMA groups: Comparison of acute inducing factors,clinical complications,and MELD scores among three groups of ACLF patients: except for the EASL group,which had a significantly higher proportion of esophageal and gastric variceal bleeding than the CMA group(P<0.05),there was no significant difference in the composition of other inducing factors among the three groups(P>0.05);The incidence of hepatic encephalopathy and hepatorenal syndrome in the EASL group was significantly higher than that in the APASL and CMA groups(P <0.05).In addition,the MELD scores of patients in the APASL,CMA,and EASL groups showed a decreasing trend.The EASL group had the highest MELD score,followed by the CMA group,and the APASL group had the lowest MELD score(P<0.05).5.The laboratory index analysis of patients with ACLF in APASL,EASL and CMA groups showed that the red blood cell count,platelet count,hemoglobin,cholinesterase,albumin and AFP in EASL group were significantly lower than those in APASL and CMA groups(P<0.05);Moreover,the levels of ALT,AST,PT,INR,APTT,and serum creatinine in the EASL group were significantly higher than those in the APASL and CMA groups(P<0.05).The FIB of the APASL group was significantly higher than that of the EASL group(P<0.05),and the total bilirubin level of the CMA group was significantly higher than that of the APASL and EASL groups(P<0.05);Except that hemoglobin in APASL group was significantly higher than that in CMA group(P<0.05),there was no significant difference in red blood cell count,platelet count,ALT,AST,cholinesterase,albumin,AFP,PT,INR,APTT,serum creatinine,and FIB between APASL group and CMA group(P>0.05).6.The analysis of organ failure in the three groups of patients showed that the incidence of coagulation system,nervous system,and renal failure in the EASL group was the highest(P<0.05),and there was no significant difference in the above organ failure between the CMA group and the APASL group.The incidence of respiratory failure in EASL group was significantly higher than that in CMA group(P<0.05).The incidence of liver failure in CMA group was significantly higher than that in APASL group and EASL group,and the incidence of EASL group was significantly higher than that in APASL group(P<0.05).7.Comparison of survival among the three groups on the 7th,28 th,and 90 th days:There was no significant difference in survival rates between the APASL group and the CMA group on the 7th and 90 th days(P>0.05),but both were significantly higher than those in the EASL group(P<0.05).The 28 th survival rate of patients in the APASL,CMA,and EASL groups showed a decreasing trend,with the highest survival rate in the APASL group,followed by the CMA group,and the lowest survival rate in the EASL group(P<0.05).Survival analysis showed that there were significant differences in survival rates among the three groups on the 7th,28 th,and 90 th days(P value of Log rank test<0.001).Patients in the APASL group had the best prognosis,followed by patients in the CMA group,and patients in the EASL group had the worst prognosis.8.Using the Delong test to compare the area under the ROC curve between the three groups,it was found that the predictive efficacy of EASL and APASL diagnostic criteria in predicting the prognosis of patients with ACLF on the 7th day was significantly better than that of CMA diagnostic criteria(P<0.05),and the predictive efficacy of EASL diagnostic criteria in predicting the prognosis of patients with ACLF on the 28 th day was significantly better than that of APASL and CMA diagnostic criteria(P<0.05);There was no significant difference in the predictive efficacy of the three diagnostic criteria in predicting the 90 th day prognosis of patients with ACLF(P>0.05).9.The sensitivity,specificity,positive predictive value,and negative predictive value of the three diagnostic criteria for predicting 7-day,28-day,and 90-day mortality in patients with ACLF were calculated.Further comparison of the sensitivity and specificity of the three diagnostic criteria showed that:(1)In predicting 7-day mortality in patients with ACLF,the sensitivity of EASL and CMA criteria(62.2%,73.3%)was significantly higher than that of APASL criteria(26.9%)(P<0.05),The specificity of EASL standard(80.1%)was significantly higher than that of CMA standard(28.4%)(P<0.05).(2)In predicting mortality in patients with ACLF,the sensitivity of the CMA standard(81.2%)was significantly higher than the APASL and EASL standards(46.4%,44.2%)(P<0.05),but the specificity of the EASL standard(84.2%)was significantly higher than the APASL and CMA standards(35.5%,31.9%).(3)In predicting 90-day mortality in patients with ACLF,the sensitivity of the CMA standard(82.1%)was significantly higher than the APASL and EASL standards(50.7%,34.8%)(P<0.05),while the specificity of the EASL standard(84.2%)was significantly higher than the CMA and APASL standards(33.7%,35.8%)(P<0.05).Conclusions:1.The value of APASL,EASL,and CMA diagnostic criteria in predicting the prognosis of ACLF patients: In predicting the prognosis of ACLF patients on the 7th day,EASL criteria performed the best;In predicting the prognosis of ACLF patients on the 28 th and 90 th days,both CMA and EASL diagnostic criteria have advantages.In clinical practice,the two diagnostic criteria can be sequentially applied to maximize the advantages of both diagnostic criteria.2.In the Chinese population,patients with ACLF defined by APASL diagnostic criteria are in the early stages of the disease,with moderate liver function,slightly lower incidence of organ failure and complications,and higher survival rates;Patients screened for EASL diagnostic criteria are often in the late stage of the disease,with poor liver function,a higher incidence of organ failure and complications,and a higher mortality rate;The severity of ACLF patients defined by the CMA diagnostic criteria is moderate,which may be more in line with clinical practice in China. |
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