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Volume 38 Issue 7
Jul.  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(7): 1482-1488

Value of lactate level in predicting the short-term prognosis of patients with acute-on-chronic hepatitis B liver failure

DOI: 10.3969/j.issn.1001-5256.2022.07.007
  • 1a.

    Center for Infectious Diseases-Hepatology of The First Affiliated Hospital, Xinjiang Medical University, Urumqi 830000, China

  • 1b.

    The First Clinical Medical College, Xinjiang Medical University, Urumqi 830000, China

  • 2.

    Xinjiang Clinical Medical Research Center for Infectious Diseases (Viral Hepatitis), Urumqi 830000, China

Research funding:

National Natural Science Foundation of China (82060115)

More Information
  • Corresponding author: SUN Xiaofeng, xjwlsxf@163.com(ORCID: 0000-0002-2596-3669)
  • Received Date: 2021-12-06
  • Accepted Date: 2022-01-22
  • Published Date: 2022-07-20
    Abstract
  •   Objective  To investigate the value of lactate in predicting the 90-day prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).  Methods  A retrospective analysis was performed for 117 patients with HBV-ACLF who were admitted to Center for Infectious Diseases-Hepatology, The First Affiliated Hospital of Xinjiang Medical University, from January 2017 to June 2021, and according to the results of 90-day follow-up, they were divided into survival group with 43 patients and death group with 74 patients. Related clinical data were collected, including routine blood test results, hepatic and renal function, coagulation function, arterial blood gas parameters, and complications such as hepatic encephalopathy within 24 hours after the diagnosis of HBV-ACLF in our hospital, and albumin-bilirubin (ALBI), Model for End-Stage Liver Disease (MELD), MELD combined with serum sodium concentration (MELD-Na), MELD to SNa ratio (MESO), integrated MELD (iMELD), and CLIF-C ACLF scores were calculated. The t-test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A binary logistic regression analysis was used to investigate whether lactate was an independent risk factor for the 90-d prognosis of HBV-ACLF patients, and a Pearson correlation analysis was used to investigate the correlation of lactate with infection and clinical complications. The receiver operating characteristic (ROC) curve was plotted to analyze whether lactate, in combination with each score, can improve the predictive value of the existing model, and the Z test was used for pairwise comparison.  Results  Compared with the survival group, the death group had significantly higher white blood cell count, international normalized ratio (INR), and lactate and a significantly lower level of Na (Z=-2.813, -2.855, and -3.186, and -2.044, all P < 0.05), as well as significantly higher age and MELD, MELD-Na, MESO, iMELD, and CLIF-C ACLF scores (t=2.536, 4.615, 4.247, 4.941, 5.832, and 7.562, all P < 0.05). The logistic regression analysis showed that age (odds ratio [OR]=1.075, 95% confidence interval [CI]: 1.026-1.127, P=0.002), INR (OR=2.198, 95%CI: 1.149-4.203, P=0.017), and lactate (OR=1.431, 95%CI: 1.002-2.044, P=0.049) were independent risk factors for the 90-day prognosis of patients with HBV-ACLF, and there was an increase in the area under the ROC curve after lactate was included in the existing models.  Conclusion  Lactate is an independent risk factor for the 90-day prognosis of patients with HBV-ACLF, and its inclusion in existing models may improve predictive value.

     

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