Composition and changing trend of the etiologies of liver failure in Shaanxi Province,China

Objective To investigate the composition and changing trend of the etiologies of liver failure in Shaanxi Province,China.Methods A retrospective analysis was performed for the clinical data of 975 patients with liver failure who were hospitalized in The First Affiliated Hospital of Xi'an Jiaotong University from January 2008 to December 2017. According to the clinical type of liver failure,the patients were divided into acute liver failure( ALF) group with 115 patients,subacute liver failure( SALF) group with 165 patients,and acute-on-chronic liver failure( ACLF) group with 695 patients. A one-way analysis of variance was used for comparison of continuous data between multiple groups,and the t-test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups. Results Drug was the primary cause of ALF( 25. 22%,29/115),followed by hepatitis B virus( HBV) infection( 21. 74%,25/115); HBV infection was the primary cause of SALF( 35. 15%,58/165),followed by drug( 27. 27%,45/165); HBV infection was the primary cause of ACLF( 87. 19%,606/695),followed by alcohol( 3. 45%,24/695). The main age distribution of patients with liver failure due to HBV infection,alcohol,and drug was 20-60 years( 595/689),30-40 years( 22/32),and30-70 years( 67/89),respectively. There was a significant reduction in the proportion of patients with HBV-related liver failure in the recent 5 years( 61. 52% vs 81. 33%,χ2= 45. 87,P < 0. 001),while there were significant increases in the proportion of patients with drug-induced liver failure( 13. 14% vs 4. 44%,χ2= 22. 10,P < 0. 001) and alcoholic liver failure( 4. 76% vs 1. 56%,χ2= 7. 85,P =0. 005). Further analysis showed that the age of onset of HBV-related liver failure in the recent 5 years was significantly higher than that in the first 5 years( 45. 3 ± 13. 0 vs 42. 5 ± 12. 9,t =-2. 567,P = 0. 011). Conclusion Management of chronic HBV infection is still an important link in the control of liver failure,and meanwhile,the prevention and treatment of drug-induced and alcoholic liver diseases should be strengthened. More attention should be paid to the treatment of elderly patients with liver failure.