Abstract:

Objective To investigate whether patients with acute⁃on⁃chronic pre⁃liver failure（pre⁃ACLF） have survival advantage compared to patients with acute ⁃on ⁃chronic liver failure（ACLF）in artificial liver treat⁃ ment. Methods A retrospective，multicenter and observational cohort study was conducted. Patients with serum hepatitis B surface antigen⁃positive for at least 6 months，serum total bilirubin ≥ 171 μmol/L and receiving at least one session of artificial liver treatment，were enrolled from January 2019 to December 2020 consecutively. Fifty⁃two patients were included in the pre⁃ACLF group，and 233 patients in the ACLF group. All patients were followed up for 12 weeks，and the survival and prognostic factors were analyzed. Kaplan Meier method and Cox regression were used to analyse the survival data. Results The 12⁃week mortality of the pre⁃ACLF group（5.8%，3/52）was lower than that of the ACLF group（34.8%，81/233），and also lower than that of early stage of ACLF group（19.9%，30/151）， middle stage of ACLF group（57.9%，33/57）and late stage of ACLF group（72.0%，18/25），respectively（all P < 0.05）. Survival analysis at 12 weeks showed that the survival for pre⁃ACLF group was better than ACLF group，and also better than that for early，middle and late stage of ACLF group，respectively（all P < 0.05）. Cox regression anal⁃ ysis showed that pre ACLF，serum alpha fetoprotein，serum sodium，age，blood leukocytes and total bilirubin were independent predictors of death（all P < 0.05），and the death risk of pre⁃ACLF patients was only 0.238 times that of ACLF patients. Conclusion Compared with ACLF patients，pre⁃ACLF patients are the survival advantage group of artificial liver treatment. Therefore，pre⁃ACLF may be the golden window of artificial liver treatment.

Key words:

acute ? on ? chronic liver failure, pre ?liver failure, artificial liver, survival advantage, prognosis