Etiology and prognostic criteria of liver failure in southeast China: A multicenter retrospective cohort study between 2018 and 2020

Abstract

Abstract Background The prognosis of patients with liver failure (LF) depends significantly on the etiologies and clinical indicators. Methods The retrospective cohort study included 637 LF patients between 2018 and 2020, including the subclasses of acute liver failure (ALF), subacute liver failure (SLF), acute-on-chronic liver failure (ACLF), subacute-on-chronic liver failure (SALF), and chronic liver failure (CLF). Multivariate logistic regression analysis was used to screen clinical indicators of death patients. We analyzed the receiver operating characteristic curves (ROCs) and cut-off values to assess prognosis criteria. Results HBV infection was present in 64.52% of LF patients. SALF (41.36%) is the main subclass of the hepatitis B virus-related LF (HBV-LF) group, while chronic liver failure (32.30%) is the main subclass of the non-HBV-related LF group in southeast China. Between 2018 and 2020, the incidence of HBV-LF decreased significantly, ranging from 72.36–59.74%, and the spontaneous survival rates of HBV-LF patients were substantially lower than those of the non-HBV-LF group (36.43 ~ 44.93% vs. 58.97 ~ 63.64%). Infection and cirrhosis were the primary causes of both groups. The age and total bilirubin value of the HBV-LF dead patients were significantly higher, and the number of days of hospitalization was significantly shorter than those of the survivors. The ages of the dead patients of the non-HBV-LF group were significantly higher than those of the survivors. The prothrombin time-international normalized ratio (PT-INR) of 2.05, 1.92, or 2.11, and antithrombin III (AT III) of 24.50%, which were proposed as prognostic criteria for the HBV-SALF, non-HBV-subacute liver failure, non-HBV-acute-on-chronic liver failure, and HBV-acute liver failure subclasses, respectively. Conclusions The incidence of HBV-LF is decreasing yearly. AT III, as a new prognostic criterion, has an excellent discriminative ability on the outcomes of the HBV-ALF subclass.