Analysis of the causes and prognostic factors of acute liver failure and acute-on-chronic liver failure
WEI Guizhi
FAN Feifei
WANG Yutong
Abstract：Objective To analyze the causes and prognostic factors of patients with acute liver failure(ALF)and acute-on-chronic liver failure(ACLF).Methods A total of 124 patients with ALF and ACLF who were admitted from January 2020 to January 2025 were selected as the study subjects.The causes of the patients and the treatment methods[including artificial liver(plasma exchange method)and simple internal medicine treatment]were retrospectively analyzed.The study subjects were divided into the effective group(n=53)and the ineffective group(n=71)based on the treatment effect.The general data and laboratory test indicators of the two groups were compared,and then a multivariate logistic regression analysis was conducted to identify the factors related to the prognosis of the patients.The receiver operating characteristic(ROC)curve was used to analyze the value of relevant indicators in predicting the treatment ineffectiveness of the patients.Results The primary cause of ALF and ACLF was hepatitis B virus infection in 37 cases(29.84%).The second most common cause was drug poisoning(23 cases,18.55%),among which 13 cases were caused by traditional Chinese medicine.Another 23 cases(18.55%)were secondary to other organ failures.Patients with ALF and ACLF induced by drug poisoning,secondary to biliary obstruction,secondary to other organ failures,various toxic substance poisoning,immune hepatitis,and hepatolenticular degeneration received simple internal medical treatment or artificial liver treatment,and the effective rate was relatively high.However,patients with ALF and ACLF caused by hepatitis B virus,other viral hepatitis,and unexplained etiology had a lower effective rate.Only patients secondary to biliary obstruction or various toxic poisonings showed a higher effective rate after receiving artificial liver treatment.There was no significant difference in the total effective rate between simple internal medical treatment and artificial liver treatment for all ALF or ACLF patients with various causes(P>0.05).Multivariate logistic regression analysis showed that the total bilirubin(TBil)level on the third day was an independent risk factor affecting the prognosis of ALF and ACLF patients(P<0.05).ROC curve analysis showed that when the TBil level on the third day was>184.9 μmol/L,the area under the curve for predicting ineffective treatment in ALF and ACLF patients was 0.656,with a sensitivity of 64.15%and a specificity of 66.20%.Conclusion The mortality rates of ALF and ACLF patients are high,and hepatitis B remains the leading cause.Additionally,drug poisoning and acute liver failure secondary to other organ failures have been increasing year by year.Artificial liver treatment does not effectively improve the prognosis of patients with ALF and ACLF.The TBil level on the third day of admission has good predictive value for the prognosis of patients with ALF and ACLF.
Keywords：acute liver failureacute-on-chronic liver failureetiology analysisartificial liverprognosisinfluencing factortotal bilirubinreceiver operating characteristic curve
Publication Date：2026-03-13
Online Publishing Date：2026-03-20(First online date of this platform, not the publication date of the document)
Pages：7( 23-29 )