Objective To explore the short-term prognosis and related factors in patients with HBV-related acute-on-chronic liver failure(HBV-ACLF)complicated with spontaneous bacterial peritonitis(SBP).Methods The clinical data of 171 patients with HBV-ACLF complicated with SBP admitted to the Fifth Medical Center of PLA General Hospital from January 2014 to December 2016 were retrospectively analyzed.Patients were divided into survival group(n=114)and death group(n=57)based on 28-day survival status.Logistic regression analysis was used to analyze the risk factors associated with 28-day mortality in patients with HBV-ACLF complicated with SBP,and to construct a prediction model.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the predictive value of the model for the short-term prognosis of patients with HBV-ACLF complicated with with SBP.Results In the death group,the incidence rates of hepatic encephalopathy(HE)(68.42％,39/57),acute kidney injury(AKI)(73.68％,42/57),WBC[10.23(6.88,14.82)×109/L],ALT[137.00(51.00,370.00)U/L],blood glucose(GLU)[5.70(4.10,7.60)mmol/L],serum creatinine(Cr)[112.00(89.00,147.00)μmol/L],international normalized ratio(INR)[2.19(1.88,2.55)％],and model for end-stage liver disease(MELD)score[28.29(24.95,33.10)]were higher than those in the survival group,with statistically significant differences(x2=18.900,18.714,Z=-3.757,-2.117,-2.085,-2.441,-2.423,-3.906,P＜0.001,＜0.001,＜0.001,=0.034,0.037,0.016,0.013,＜0.001).Multivariate analysis showed that blood WBC(OR=1.120,95％CI:1.046-1.199),GLU(OR=1.120,95％CI:1.018-1.232),and MELD score(OR=1.089,95％CI:1.018-1.165)were independent risk factors for 28-day mortality in patients with HBV-ACLF complicated with SBP.A prediction model was constructed as Y=0.113GLU+0.113WBC+0.085MELD-4.967.The area under the ROC curve of the prediction model was 0.737,which was higher than that of the MELD score of 0.667(Z=-11.341,P＜0.001).Conclusions The short-term prognosis in patients with HBV-ACLF complicated with SBP is poor.MELD score,WBC,and GLU are short-term prognostic factors for these patients,and their combined use has a higher predictive value for short-term prognosis.
Acute-on-chronic liver failurePrimary bacterial peritonitisHepatitis B virusPrognosis
NETL
NSTL
万方数据
