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Volume 41 Issue 7
Jul.  2025
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Article Navigation >  Journal of Clinical Hepatology  > 2025  >  41(7): 1388-1393

Short-term prognosis of patients with alcohol-related liver diseases-acute-on-chronic liver failure comorbid with infection

DOI: 10.12449/JCH250724

  • Senior Department of Hepatology，The Fifth Medical Center of PLA General Hospital，Beijing 100039，China

Research funding:

National Key R&D Program of China (2021YFC2301801)

More Information
  • Corresponding author: SU Haibin， suhaibin302@163.com （ORCID： 0000-0002-7958-5974）
  • Received Date: 2024-11-17
  • Accepted Date: 2024-12-30
  • Published Date: 2025-07-25
    Abstract
  •   Objective  To investigate the influencing factors for the short-term prognosis of patients with alcohol-related liver diseases-acute-on-chronic liver failure （ALD-ACLF） comorbid with infection.  Methods  A total of 89 ALD-ACLF patients with infection who were admitted to theFifth Medical Center of PLA General Hospital from January 2019 to December 2021 were enrolled as subjects， and related clinical data were collected at baseline （time of patient enrollment）. According to the 28-day survival status of patients， they were divided into survival group with 53 patients and death group with 36 patients， and baseline clinical data were compared between the two groups. The t-test was used for comparison of normally distributed continuous data between groups， and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between groups； the chi-square test was used for comparison of categorical data between groups. A non-conditional Logistic regression analysis was used to perform the multivariate analysis. The Z-test was used for comparison of the area under the ROC curve （AUC）， and the diagnostic value of the model was assessed.  Results  Compared with the survival group， the death group had significantly higher hemoglobin （t=-2.397， P=0.019）， alanine aminotransferase （Z=-3.437， P=0.001）， gamma-glutamyl transpeptidase （Z=-2.617， P=0.009）， creatinine （Z=-3.938， P<0.001）， blood urea nitrogen （Z=-3.423， P=0.001）， NH3 （Z=-4.406， P<0.001）， international normalized ratio （Z=-3.428， P=0.001）， C-reactive protein （Z=-2.128， P=0.033）， procalcitonin （Z=-2.441， P=0.015）， Model for End-Stage Liver Disease （MELD） score （t=-4.817， P<0.001）， incidence rate of acute kidney injury （χ2=21.602， P<0.001）， incidence rate of pulmonary infection （χ2=4.866， P=0.027）， and incidence rate of shock （χ2=16.285， P<0.001）， as well as significantly lower albumin （Z=-2.473， P=0.013） and incidence rate of abdominal infection （χ2=5.897， P=0.015）. The multivariate analysis showed that NH3 （odds ratio ［OR］=1.027， 95% confidence interval ［CI］： 1.006‍ ‍—‍ ‍1.049， P=0.012）， MELD score （OR=1.103， 95%CI： 1.011‍ ‍—‍ ‍1.203， P=0.027］， and the incidence rate of shock （OR=6.326， 95%CI： 1.533‍ ‍—‍ ‍26.101， P=0.011） were independent risk factors for 28-day mortality in ALD-ACLF patients comorbid with infection. Based on these factors， a predictive model was established as Y=0.027×NH3+0.098×MELD score+1.845×shock-4.111. The ROC curve analysis showed that the new model had an AUC of 0.861， a sensitivity of 77.78%， and a specificity of 88.68%， while MELD score had an AUC of 0.776， a sensitivity of 77.78%， and a specificity of 67.92%， suggesting that the new model had a significantly higher diagnostic value than MELD score （Z=2.136， P=0.032 6）.  Conclusion  ALD-ACLF patients with infection tend to have a poor short-term prognosis， and MELD score， NH3， and shock are influencing factors for the short-term prognosis of such patients. The combination of these three factors has a high value in predicting short-term prognosis.

     

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