title: Prognostic performance of clinical indices and model scorings for acute-on-chronic liver failure: A study of 164 patients.
abstract: The present study aimed to analyze the prognostic factors of acute-on-chronic liver failure (ACLF), with the perspective of an improved selection of optimal therapeutic schemes. A retrospective analysis was used to study 164 patients with ACLF hospitalized between 2010 and 2014 in a single center. Patients were divided into favorable and unfavorable groups, according to the treatment outcomes. General characteristics and clinical manifestations were analyzed to determine whether they would affect the prognosis of the patients with ACLF, with a particular focus on the scoring systems Child-Pugh, model for end-stage liver disease (MELD), MELD with incorporation of sodium (MELD-Na), MELD and serum sodium ratio (MESO) and integrated MELD (iMELD). Hepatitis B virus infection was the predominant cause of ACLF, accounting for 88 cases (53.7%). Age, prothrombin time, thrombin time, international normalized ratio (INR), prothrombin activity, serum sodium, albumin, total bilirubin, serum creatinine, platelets, fasting blood sugar, infections, hepatic encephalopathy, hepatorenal syndrome (HRS), and electrolyte disorder were revealed to be associated with prognosis. Age, serum sodium, INR, HRS, and infection were independent prognostic risk factors, as determined by multivariate analysis. Child-Pugh, MELD, MELD-Na, MESO and iMELD scoring systems all demonstrated adequate predictive values, with MELD-Na as the most effective scoring system. In conclusion, age, hyponatremia, INR, HRS and bacterial or fungal infections were reported to be independent prognostic risk factors for ACLF. Among the various liver function scoring systems, MELD-Na was the most accurate in predicting the prognosis of ACLF.
authors.affiliation: Department of Hepatobiliary and Pancreatic Diseases, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
authors.forename: Qianqian
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary and Pancreatic Diseases, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
authors.forename: Xiaolin
authors.initials: X
authors.lastname: Guo
authors.affiliation: Department of Intensive Care Unit, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China.
authors.forename: Shixing
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Department of Hepatobiliary and Pancreatic Diseases, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Pang
authors.affiliation: Department of Hepatobiliary and Pancreatic Diseases, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Infectious Diseases, China-Japan Friendship Hospital, Beijing 100029, P.R. China.
authors.forename: Yujiao
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Hepatobiliary and Pancreatic Diseases, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China.
authors.forename: Baorong
authors.initials: B
authors.lastname: Chi
keywords: acute-on-chronic liver failure; hepatic encephalopathy; hepatorenal syndrome; predictive value of tests; prognosis