Abstract: Objective To investigate the factors related to the prognosis of acute-on-chronic liver failure (ACLF) and the efficacy of common prognostic scoring models in China and abroad, and to analyze the efficacy of single and combined scoring models including alpha fetoprotein (AFP) and lactate dehydrogenase (LDH) indexes in the evaluation of the prognosis of patients with ACLF. Methods The clinical data of patients with ACLF admitted to our hospital from 2010 to 2021 were collected, and the influencing factors of prognosis were analyzed by statistical methods. The prognostic value of the single index of AFP/LDH and the new scoring model for ACLF was analyzed by comparing to common assessment model. Results A total of 159 patients with ACLF were enrolled, with a survival to death ratio of 129∶30 and 111∶48 within 28 and 90 days respectively. Among them, 48 cases were classified as early stage, 58 cases as middle stage and 53 cases as late stage according to the severity of the disease. According to the prognosis within 90 days, patients were divided into survival group and death/liver transplantation group. The baseline indexes including alanine transaminase (ALT) (410 vs 204), aspartate aminotransferase (AST) (296 vs 211), ALT/AST (1.27 vs 0.88), total bilirubin (TBil) (271 vs 349), cholesterol (2.7 vs 2.2), triglyceride (TG) (1.07 vs 0.81), neutrophil count (6.35 vs 6.21), urea nitrogen (3.7 vs 6.0), lymphocyte count (1.45 vs 0.69), neutrophil count/lymphocyte count (2.38 vs 7.04), red blood cell (RBC) count (4.19 vs 3.60), hemoglobin (Hb) (132 vs 119), platelet count (90 vs 74), HBV DNA load (104 vs103), prothrombin activity (PTA) (37.1 vs 30.3), international normalized ratio (INR) (2.09 vs 2.56), MLR(0.37 vs 0.61), serum creatinine (59 vs 64), LDH (221.0 vs 279.5), AFP (82.30 vs 7.66), hepatic encephalopathy, ascites, MELD score (20.57 vs 26.34) and COSSH score (5.05 vs 6.08) between the 2 group were significantly different (P<0.05). There was no significant difference in age, gender, albumin, prealbumin, serum uric acid, direct bilirubin, indirect bilirubin, cholinesterase, serum sodium, serum ammonia, R-glutamyl transpeptidase, ALBI, glutamyl transpeptidase and glutamyl transpeptidase between the 2 groups (P>0.05). AFP, LDH, TBil, TG, RBC, Hb, glutamate/propyl glutamate (GLU), urea nitrogen/creatinine (UREA nitrogen/creatinine) and the new score including AFP and LDH were independent factors for predicting the prognosis of ACLF at 90 days. The predictive value of new scoring model (AUC = 0.87, sensitivity 89.6%, specificity 75.7%, cutoff -0.9909) was better than that of traditional NLR (AUC=0.72, sensitivity 68.9%, specificity 75.2%, Cutoff 3.86), MELD (AUC=0.67, sensitivity 69.6%, specificity 67%, cutoff value 14.64), COSSH (AUC=0.76, sensitivity 75%, specificity 76%, cutoff value 5.37) in patients with ACLF. Conclusion In the study of prognostic factors in patients with ACLF, ADH, TBil, urea nitrogen/creatinine, ALT/AST, erythrocyte, are independent risk factors for predicting the prognosis of ACLF patients within 90 days, while triglyceride, AFP, Hb are independent protective factors. In the study, the new scoring system consisting of the above 8 indicators is more accurate than MELD and NLR in predicting prognosis in all ACLF patients, and the new scoring has higher predictive power than MELD and NLR in the study in hepatitis B patients, but the difference is not statistically significant compared with COSSH, but overall the new scoring still has high predictive power Thus saving the use of clinical organs and providing the best treatment plan.

Key words: Acute-on-chronic liver failure, Analysis of risk factors, Scoring model, Lactic dehydrogenase, Alpha fetal protein