Abstract:

Objective

To evaluate the predictive value of prothrombin activity-to-albumin ratio（PTAAR） for the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure （ACLF）.

Methods

Clinical data of 286 ACLF patients admitted to the Third Affiliated Hospital of Sun Yat-sen University from 2019 to 2020 were retrospectively analyzed. The local ethical committee approval was received. Among them，243 patients were male and 43 female，aged 19-75 years，with a median age of 46 years. The patients received 3-month follow-up. All patients were divided into the survival group（n=238） and death group （n=48）. General data，biochemical parameters and coagulation function of patients were collected. The influencing factors of clinical prognosis of ACLF patients were screened by Logistic regression analysis. ACLF prediction model was constructed based on PTAAR. The predictive value of PTAAR model was evaluated by using the receiver operating characteristic （ROC） curve.

Results

The 3-month mortality rate of ACLF patients was 16.8%（48/286）. Multivariate Logistic regression analysis showed that age，total bilirubin （TB） and PTAAR were the independent factors affecting the short-term prognosis of ACLF patients （OR=1.058，1.003，0.212； P＜0.05）. The prediction model for short-term prognosis of ACLF patients was established based on PTAAR: Logit （P）=-4.365+0.077×Age+0.003×TB-1.813×PTAAR. The area under the ROC curve （AUC） of PTAAR model was 0.782 （95%CI: 0.711-0.853），significantly larger than 0.671 （95%CI: 0.583-0.758） of MELD score （Z=2.381， P＜0.05）. The cutoff values of the model based on PTAAR and MELD score were 0.133 and 22.886，and 0.854 and 0.792 for the sensitivity，and 0.601 and 0.529 for the specificity，respectively.

Conclusions

The 3-month mortality rate of patients with hepatitis B-related ACLF is relatively high. PTAAR is a predictor for the 3-month prognosis of patients with ACLF. The prediction model based on PTAAR can achieve higher prediction performance.

Key words: Liver failure, Prothrombin activity to albumin ratio （PTAAR）, Model for endstage liver disease （MELD）, Prognosis