Abstract:Objective: To investigate the short-term prognostic risk factors of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) treated with artificial liver and to establish a prognostic evaluation model. Methods: The model for end stage liver disease (MELD) combined with total bilirubin rebound rate (TBRR) was used to establish a 90-day prognostic model for HBV-ACLF patients. The relevant laboratory indexes of 114 patients with HBV-ACLF before and after artificial liver treatment in our hospital were retrospectively analyzed. According to the outcome of 90 days after admission, they were divided into the survival group and the death group. The risk factors of patients’short-term death were tested by univariate analysis, binary logistic regression analysis and other methods, the predictive model was establish, and the ROC curve was drawn to compare the predictive value. Results: Total bilirubin (TBil), creatinine (Crea), prothrombin time (PT), international normalized ratio (INR), TBRR, total bilirubin actual resident rate (TBARR), MELD, MELD and Child-Turcotte-Pugh (CTP) in the death group were higher than those in the survival group, while prothrombin activity (PTA) was lower than those in the survival group (P<0.05). There was no significant difference in total bilirubin clearance rate (TBCR) between groups (P=0.852). Binary logistic regression analysis revealed that TBRR, MELD and CTP were independent risk factors for 90-day mortality in patients with HBV-ACLF. Three prognostic prediction models of MELD, MELD-TBRR and MELD-TBRR-CTP were established, with the area under the receiver operating characteristic curve (AUC) of 0.786, 0.875 and 0.897, sensitivity of 58.33%, 88.46%, and 86.11%, and specificity of 70.51%, 86.11%and 79.49%, respectively. There was no significant difference in AUC between MELD-TBRR and MELD-TBRR-CTP (P=0.200). Conclusion: TBRR, MELD and CTP are independent risk factors for short-term mortality of patients with HBV-ACLF treated with artificial liver, and MELD combined with TBRR has a good predictive value for short-term prognosis of HBV-ACLF after artificial liver treatment.
