VALUE OF COMBINED SCORE OF MODEL FOR END-STAGE LIVER DISEASE AND ALPHA-FETOPROTEIN IN PREDICTING THE PROGNOSIS OF PATIENTS WITH ACUTE-ON-CHRONIC LIVER FAILURE AND INFLUENCING FACTORS FOR PROGNOSIS

Abstract

Objective To investigate the value of the combined score of Model for End-Stage Liver Disease (MELD) and alpha-fetoprotein (AFP) in predicting the prognosis of patients with acute-on-chronic liver failure (ACLF) and the influencing factors for the prognosis of patients with ACLF. Methods A retrospective analysis was performed for the clinical data of the patients with ACLF who were admitted to The Affiliated Hospital of Qingdao University and The Qingdao Sixth People’s Hospital from September 2015 to September 2021, and according to the prognosis on day 90 after diagnosis, they were divided into survival group and death group. The influencing factors for the prognosis of ACLF patients were analyzed, as well as the performance of serum AFP level, MELD score, and MELD-AFP combined score in predicting the short-term prognosis of patients. Results A total of 159 patients with ACLF were enrolled; 129 patients survived and 30 patients died on day 28 after diagnosis, while 111 patients survived and 48 patients died on day 90 after diagnosis. Serum AFP level, lactate dehydrogenase level, red blood cell count, hemoglobin level, alanine aminotransferase/aspartate aminotransferase ratio, urea nitrogen/creatinine ratio, and MELD score were independent influencing factors for the prognosis of ACLF patients on day 90 after diagnosis. Compared with MELD score, MELD-AFP combined score had better performance in predicting the prognosis of ACLF patients on day 90 after diagnosis, with an area under the ROC curve of 0.81. Conclusion Increases in serum lactate dehydrogenase level, urea nitrogen/creatinine ratio, alanine aminotransferase/aspartate aminotransferase ratio, red blood cell count, serum AFP level, and serum hemoglobin level are closely associated with the prognosis of ACLF patients on day 90 after diagnosis. MELD-AFP combined score significantly optimizes the performance of traditional MELD score in predicting the short-term prognosis of ACLF patients.

Keywords

• acute-on-chronic liver failure|model, theory|end-stage liver disease|alpha-fetoprotein|prognosis|risk factors