Prognosis and adverse reactions of patients with acute-on-chronic liver failure receiving artificial liver support therapy stratified by international normalized ratio
10.3969/j.issn.1001-5256.2022.10.020
- VernacularTitle:国际标准化比值不同分层的慢加急性肝衰竭患者行人工肝治疗的预后及不良反应观察
- Author:
Yuyu ZENG
1
;
Dakai GAN
1
;
Nengwen XIE
1
;
Jiao WAN
1
;
Molong XIONG
1
Author Information
1. Department of Severe Liver Disease, The Ninth Hospital of Nanchang, Nanchang 330002, China
- Publication Type:Original Article_Other Liver Diseases
- Keywords:
Acute-On-Chronic Liver Failure;
Liver, Artificial;
International Normalized Ratio;
Prognosis
- From:
Journal of Clinical Hepatology
2022;38(10):2308-2312
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the prognosis and adverse reactions of patients with acute-on-chronic liver failure (ACLF) receiving artificial liver support therapy stratified by international normalized ratio (INR). Methods A total of 515 ACLF patients who received artificial liver support therapy in Department of Severe liver Disease, The Ninth Hospital of Nanchang, from January 2010 to May 2020 were enrolled, and according to the level of INR, they were divided into group A with 20 patients (INR < 1.5), group B with 115 patients (1.5≤INR < 1.9), group C with 179 patients (1.9≤INR < 2.6), group D with 61 patients (2.6≤INR < 3.2), group E with 75 patients (3.2≤INR < 4.2), and group F with 65 patients (INR≥4.2). All patients received multimodality medical treatment combined with artificial liver support therapy. The one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups。The chi-square test was used for comparison of categorical data between groups. Bonferroni correction was used for further comparison between two groups. and the receiver operating characteristic (ROC) curve was used to evaluate the value of INR and MELD scoring system in predicting the prognosis of ACLF patients. Results As for 90-day mortality rate, there was a significant difference between the six groups stratified by INR ( χ 2 =124.84, P < 0.001); there was no significant difference between groups A(25%), B(25.2%), and C(39.7%) ( P > 0.05), and there was a significant difference between groups D/E/F(65.6%, 82.7%, and 92.3%, respectively) and groups A/B/C (all P < 0.05); there was no significant difference between groups D and E and between groups E and F ( P > 0.05), and there was a significant difference between groups D and F ( P < 0.05). There was no significant difference in the incidence rate of intraoperative adverse reactions between the six groups ( χ 2 =8.956, P =0.111). INR had an area under the ROC curve of 0.786 (95% confidence interval: 0.746-0.825, P < 0.001) in predicting the prognosis of patients with ACLF receiving artificial liver support therapy, with a sensitivity of 66.7% and a specificity of 79.8%. Conclusion INR has a good value in predicting the prognosis of ACLF patients receiving artificial liver support therapy, and the artificial liver has good safety.
