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Abstract：
Objectives This study aimed to identify the causes, clinical characteristics, and 28-day in-hospital mortality predictors in patients with acute-on-chronic liver failure (ACLF). Methods A cross-sectional study enrolled sixty-four patients aged 18-70 years with acute-on-chronic liver failure. The study was conducted at the Gastroenterology Department, Lahore General Hospital. The study classified ACLF according to the criteria of the European Association for the Study of the Liver - Chronic Liver Failure (EASL-CLIF). Patients were followed for 28 days for mortality outcomes. The outcomes between Survivor and Non-survivor groups were compared using the Chi-Square/Fisher\'s Exact Test for categorical variables and the Mann-Whitney U test for continuous variables. Results In this study, age and duration of chronic liver disease were not significantly different between survivors and non-survivors. The etiology of liver disease and ACLF causes had no impact on 28-day mortality. Non-survivors had lower mean arterial pressure, and higher mortality was linked with lower Glasgow Coma Scale scores, upper gastrointestinal bleeding, and Grade IV hepatic encephalopathy. Significant differences in bilirubin, serum creatinine, urea, and C-reactive protein levels were observed at 28 days. Survival rates were highest with single organ failure (35.94%) and decreased with multiple organ failures. The overall survival rate was 51.56%. Predictive validity for mortality was assessed using the Area Under the Curve (AUC), with Child-Turcotte-Pugh (CTP) at 0.679, Model for End-Stage Liver Disease (MELD) at 0.819, and Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) at 0.771. Conclusion This study concludes that in acute-on-chronic liver failure, factors like age, gender, and disease etiology do not significantly predict 28-day mortality. Key mortality indicators include clinical parameters such as lower Glasgow Coma Scale scores, hepatic encephalopathy Grade IV, and laboratory findings like elevated bilirubin and serum creatinine. The MELD score is the most compelling prognostic tool.
摘要：
目的本研究旨在找出原因，临床特征,慢性急性肝衰竭（ACLF）患者的28天住院死亡率预测因素。方法一项横断面研究纳入64例年龄在18-70岁的慢加急性肝衰竭患者。这项研究是在消化内科进行的，拉合尔总医院。该研究根据欧洲肝-慢性肝衰竭研究协会（EASL-CLIF）的标准对ACLF进行分类。随访患者28天的死亡率结果。对分类变量采用卡方/Fisher精确检验和连续变量采用Mann-WhitneyU检验比较幸存者和非幸存者组的结果。结果在这项研究中，慢性肝病的年龄和病程在幸存者和非幸存者之间无显著差异.肝病的病因和ACLF原因对28天死亡率没有影响。非幸存者的平均动脉压较低，较高的死亡率与较低的格拉斯哥昏迷评分有关，上消化道出血,和IV级肝性脑病。胆红素的显著差异，血清肌酐,尿素,在28天观察到C反应蛋白水平。单器官衰竭的生存率最高（35.94％），多器官衰竭的生存率降低。总生存率为51.56%。使用曲线下面积（AUC）评估死亡率的预测有效性，Child-Turcotte-Pugh（CTP）为0.679，终末期肝病模型（MELD）为0.819，慢性肝衰竭序贯器官衰竭评估（CLIF-SOFA）为0.771。结论本研究得出结论，在慢性急性肝衰竭中，像年龄这样的因素，性别,和疾病的病因并不能显著预测28天的死亡率。主要死亡率指标包括临床参数，如格拉斯哥昏迷评分较低，肝性脑病IV级,以及胆红素和血清肌酐升高等实验室检查结果.MELD评分是最有说服力的预后工具。
