Analysis of prognosis-related factors in patients with hepatitis B virus-related acute-on-chronic liver failure
10.3760/cma.j.cn501113-20200630-00354
- VernacularTitle:晚期乙型肝炎相关慢加急性肝衰竭患者预后相关因素分析
- Author:
Mengying SUN
1
;
Beijin CHEN
;
Hao LI
;
Xiaoping WANG
;
Sen QIN
;
Shanhong TANG
Author Information
1. 西南交通大学医学院，成都 610083
- Keywords:
Acute-on-chronic liver failure;
Advanced;
Prognosis;
Liver regeneration
- From:
Chinese Journal of Hepatology
2021;29(10):983-986
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the prognosis-related factors and its predictive value in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).Methods:Sixty-three cases with HBV-ACLF were enrolled. According to the prognosis of 4-weeks, patients were divided into survival and death group. Univariate and multivariate analyses were performed on the clinical data of the two groups of patients to screen the risk factors affecting prognosis, evaluate its predictive value, and compare them with the MELD score, CTP score, and CLIFACLF score. The data were analyzed using t-test, Mann-Whitney U test, χ2 test. Multiple logistic regression analysis was used for multiple risk factors. Results:There were 63 cases with HBV-ACLF, with 16 cases (25.40%) in the 4-week survival group, and 47 cases (74.60%) in the death group. The survival group age was 38.38 ± 14.50 years, which was significantly lower than the age of the death group 52.28 ± 12.51 years ( P < 0.001). The survival group alpha-fetoprotein (AFP) level was 91.21 (8.38 ~ 154.10)μg/L, which was significantly higher than the level of the death group [12.60 (5.70 ~ 33.80) μg/L, P = 0.039]. The survival group alanine aminotransferase (ALT) level was 925.65 (523.43 ~ 1 364.80) U/L, which was much higher than that of the death group [371.60 (117.30 ~ 895.30) U/L, P = 0.040]. The survival group serum sodium level was (136.59 ± 4.03) mmol /L, which was significantly higher than the level of the death group [(132.22 ± 6.37) mmol/L, P = 0.013]. The survival group ascites severity level was much lower than that of the death group ( P = 0.008). The survival group creatinine level was 56.50(49.43 ~ 86.25) μmol/L, which was much lower than the level of the death group [86.20 (68.00 ~ 143.00) μmol/L, P = 0.003]. Multivariate logistic regression analysis showed that ascites ( OR = 0.470, 95% CI: 0.226 ~ 0.977) and age ( OR = 0.941, 95% CI: 0.888 ~ 0.996) were risk factors affecting the HBV-ACLF prognosis. The area under the curve predicted liver failure prognostic score for ascites and age was 0.821, and the sensitivity and specificity were 68.8% and 87.2%, which was higher than the area under the curve predicted by the MELD score, CTP score, and CLIFACLF score, respectively. Conclusion:Age and ascites can be used to predict the clinical outcome in patients with HBV-ACLF. Younger patients without ascites have a higher survival rate at 4-weeks, but older patients with ascites are more likely to have a lower survival rate.
