Objective To investigate the 28-day incidence rate of acute-on-chronic liver failure( ACLF) and the 90-day prognosis of patients with acute deterioration( AD) of hepatitis B virus( HBV)-related liver cirrhosis( LC). Methods A total of 670 patients with AD of HBV-related LC who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from October 2014 to October 2016 were enrolled,and according to total bilirubin( TBil) and prothrombin time activity( PTA),they were divided into group A with 134 patients( 51. 3 μmol/L < TBil < 171. 1 μmol/L and PTA < 40%),group B with 393 patients( 51. 3 μmol/L < TBil < 171. 1 μmol/L and40% ≤PTA < 60%),and group C with 143 patients( TBil > 171. 1 μmol/L and 40% < PTA < 60%). The patients were analyzed in terms of clinical features,28-day incidence rate of ACLF and its influencing factors,and 90-day survival and its influencing factors. Ananalysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups. The chi-square test or the Fisher's exact test was used for comparison of categorical data between multiple groups. The Kaplan-Meier method was used to calculate cumulative incidence rate,and the log-rank test was used for comparison between groups. Cox regression analysis and logistic regression analysis were used to investigate the influencing factors for the onset of ACLF and 90-day survival. Results There were significant differences between groups A,B,and C in Model for End-Stage Liver Disease score( 20. 2 ± 4. 6 vs 14. 7 ± 3. 6 vs 22. 7 ± 5. 6,F = 211. 118,P < 0. 001) and Child-Pugh score( 10. 6 ± 0. 8 vs 9. 3 ± 1. 2 vs10. 4 ± 1. 2,F = 66. 427,P < 0. 001),and group B had significantly lower scores than groups A and C( all P < 0. 05). Among the 670 patients,69( 10. 3%) developed ACLF within 28 days,with 19 patients( 14. 2%) in group A,17 patients( 4. 3%) in group B,and 33 patients( 23. 1%) in group C. Group B had a significantly lower incidence rate of ACLF than group A( χ2= 15. 937,P < 0. 001) and group C( χ2= 48. 502,P < 0. 001). In group A,aspartate aminotransferase( AST)( risk ratio [RR]= 1. 033,P = 0. 030),bacterial infections( BIs)( RR = 14. 326,P = 0. 001),blood sodium( Na)( RR = 0. 888,P = 0. 019),and alpha-fetoprotein( AFP)( RR = 1. 003,P <0. 001) were independent influencing factors for ACLF; in group B,male sex( RR = 0. 201,P = 0. 035),alanine aminotransferase( RR =0. 996,P = 0. 006),AST( RR = 1. 008,P < 0. 001),gamma-glutamyl transpeptidase( RR = 1. 004,P = 0. 018),PTA( RR = 0. 642,P < 0. 001),TBil( RR = 1. 039,P = 0. 002),BIs( RR = 49. 656,P < 0. 001),and HBV DNA( RR = 2. 206,P < 0. 001) were independent influencing factors for ACLF; in group C,acute variceal bleeding( AVB)( RR = 3. 172,P = 0. 025) and BIs( RR = 2. 946,P =0. 007) were independent influencing factors for ACLF. Of all 670 patients,79( 11. 8%) died within 90 days,with 29 patients( 21. 6%)in group A,15 patients( 3. 8%) in group B,and 35 patients( 24. 5%) in group C,and group B had a significantly lower mortality rate than group A( χ2= 41. 492,P < 0. 001) and group C( χ2= 52. 905,P < 0. 001). In each group,the patients with ACLF had a significantly higher 90-day mortality rate than those without ACLF( group A: χ2= 4. 151,P = 0. 042; group B: P = 0. 022; group C: χ2= 16. 968,P< 0. 001). In group A,creatinine( odds ratio [OR]= 1. 075,P = 0. 007) and Na( OR = 0. 450,P < 0. 001) were independent influencing factors for 90-day survival; in group B,AVB( OR = 1378. 999,P = 0. 026) and Na( OR = 0. 392,P = 0. 018) were independent influencing factors for 90-day survival; in group C,AVB( OR = 31. 699,P = 0. 038),Na( OR = 0. 841,P = 0. 023),and development of ACLF( OR = 14. 258,P = 0. 017) were independent influencing factors for 90-day survival. Conclusion Patients with AD of HBV-related LC can be divided into three clinical types,and the patients with high jaundice type( group C) or low coagulation type( group A) tend to develop ACLF and have poorer prognosis. BIs are the common influencing factor for ACLF in these three types of patients,and blood Na level is the common influencing factor for 90-day prognosis.
DownLoad: