Current status of research on the prognostic markers for acute-on-chronic liver failure / 临床肝胆病杂志

Acute-on-chronic liver failure (ACLF) is a syndrome characterized by multiple organ failure and high short-term mortality rate, and it has always been a research hotspot in the field of severe liver diseases. Therefore, early and accurate risk stratification and timely intervention are of great significance to improve prognosis. This article summarizes the serum biomarkers identified in recent years for evaluating the prognosis of patients with ACLF, and it is pointed out that new serum biomarkers have an important guiding significance in the prognostic evaluation of ACLF patients.

Value of albumin-bilirubin score in predicting the prognosis of patients with liver cirrhosis and esophagogastric variceal bleeding / 临床肝胆病杂志

ObjectiveTo investigate the value of albumin-bilirubin (ALBI) score in evaluating the prognosis of patients with liver cirrhosis and esophagogastric variceal bleeding, and to compare it with Child-Turcotte-Pugh (CTP) score and Model for End-stage Liver Disease combined with serum sodium concentration (MELD-Na) score. MethodsA retrospective analysis was performed for the clinical data of 155 patients who were diagnosed with liver cirrhosis and esophagogastric variceal bleeding in The First Hospital of Jilin University from August 2018 to April 2019, and according to disease outcome after 1 year of follow-up, these patients were divided into survival group with 98 patients and death group with 57 patients. The influencing factors for prognosis were analyzed, and the value of ALBI score in predicting prognosis was assessed. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. A Spearman correlation analysis was performed to investigate the correlation between two variables. A multivariate logistic regression analysis was used to investigate independent influencing factors for death within 1 year. The receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUC) was calculated; the optimal cut-off value was determined based on Youden index. The Z test was used for comparison of AUC between these three scoring systems. ResultsThere were significant differences between the survival group and the death group in initial blood loss (U=1994.5, P=0.002), presence or absence of hepatic encephalopathy (χ2=14.154, P＜0.001), severity of ascites (χ2=10.537, P=0.005), total bilirubin (U=16940, P＜0.001), albumin (t=-6.633, P＜0.001), aspartate aminotransferase (U=2223.5, P=0.035), Na (U=1859.5, P=0001), international normalized ratio (U=1259.5, P＜0.001), prothrombin time (U=1331.5, P＜0.001), white blood cell count (U=2008.5, P=0.004), red blood cell count (t=-2.633, P=0009), red blood cell volume distribution width (U=1719.5, P＜0001), hemoglobin (U=2150.0, P=0.017), ALBI grade (χ2=48.732, P＜0.001), and CTP class (χ2=34.646, P＜0.001). The death group had a significantly higher ALBI score on admission than the survival group (-1.11±0.59 vs -1.79±0.44, t=7.618, P＜0.001), as well as significantly higher MELD-Na score (18.0［14.5-24.0］ vs 12.0［10.0-16.0］, U=1176.0, P＜0.001） and CTP score （9.0［8.0-11.0］ vs 7.0［6.0-8.0］, U=1078.0, P＜0.001）. The Spearman correlation analysis showed that ALBI score was positively correlated with CTP score and MELD-Na score (r=0.753 and 0.668, both P＜0.001). The multivariate logistic regression analysis showed that ALBI score (odds ratio ［OR］=8.349, 95% confidence interval ［CI］: 2.658-26.232), CTP score (OR=1.586, 95%CI: 1.157-2.175), and MELD-Na score (OR=1.188, 95%CI: 1.062-1.328) were independent risk factors for predicting death within 1 year. The optimal cut-off value was -1.485 for ALBI score, 8.5 for CTP score, and 17.5 for MELD-Na score in predicting the 1-year prognosis of patients, with an AUC of 0.818, 0.807, and 0.789, respectively. There was no significant difference between the three scoring systems in predicting the 1-year mortality rate (P＞0.05). ConclusionThe performance of ALBI score is comparable to that of CTP and MELD-Na scores in predicting the risk of death within 1 year in patients with liver cirrhosis and esophagogastric variceal bleeding, and ALBI score has a good evaluation ability.