Predisposing factors for acute-on-chronic liver failure and their influence on prognosis

Objective To investigate the prognosis of patients with acute-on-chronic liver failure(ACLF) caused by different predisposing factors and the change in these factors within the past 10 years. Methods A retrospective analysis was performed for the clinical data of 537 ACLF patients who were hospitalized and treated in The First Affiliated Hospital of Xi'an Jiantong University and Xi'an Eighth Hospital from January 2008 to December 2017,including age,sex,etiology,predisposing factors,and prognosis(improvement/death),and the 28-day mortality rate was calculated. The t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. A Cox regression analysis was used to evaluate the influence of different predisposing factors on 28-day mortality rate. Results Among the 537 patients with ACLF,511(95. 16%) had HBV-related ACLF,3(0. 56%) had HCV-related ACLF,2(0. 37%) had alcoholic hepatitis-related liver failure,18(3. 35%) had an unclassified type,1(0. 19%) had overlapping infection of HBV and HCV,and 2(0. 37%) had ACLF associated with primary biliary cirrhosis. Among the 537 patients with ACLF,34. 8%had no predisposing factors,17. 1% did not receive standard treatment,16% had HBV-ACLF due to the withdrawal of nucleos(t) ide analogues(NAs),9. 7% had alcohol consumption,6. 9% had infections,3% had a history of surgery,and 3% had a history of medication causing liver injury. There was a significant difference in 28-day mortality rate between the patients without predisposing factors and those with the predisposing factor of surgery,infection,or withdrawal of NAs(χ2= 8. 553,11. 351,and 4. 274,all P < 0. 05). Surgery(hazard ratio[HR]=2. 132,95% confidence interval [CI]: 1. 240-3. 664,P = 0. 006) and infection(HR = 1. 942,95% CI: 1. 262-2. 989,P =0. 003) were independent risk factors for ACLF and death in patients with chronic liver diseases. As for the change in predisposing factors in the recent 10 years,the proportion of patients with drug-induced ACLF in the last five years was significantly higher than that in the first five years(χ2= 6. 365,P < 0. 05). Conclusion ACLF patients with the predisposing factors of surgery,infection,and withdrawal of NAs have a higher 28-day mortality rate than those without these predisposing factors. Surgery and infection are independent risk factors for death in patients with ACLF. There is an increase in the proportion of patients with drug-induced ACLF in the recent 5 years.