老年乙肝相关慢加急性肝衰竭患者临床特点及进展危险因素分析

目的:探讨老年乙肝相关慢加急性肝衰竭患者的临床特点及其进展的相关危险因素。方法:选取天津市第三中心医院符合亚太肝病学会慢加急性肝衰竭(APASL-ACLF)诊断标准的老年乙肝相关慢加急性肝衰竭(HBV-ACLF)患者168例，选取同期非老年HBV-ACLF患者176例作为对照组，记录其基线及进展情况；同时将老年组根据是...

Clinical characteristics and progression risk factors for hepatitis B-related acute-on-chronic liver failure in elderly patients

Objective To investigate the clinical characteristics and risk factors for the progression of acute-on-chronic liver failure(ACLF)associated with hepatitis B in elderly patients.Methods A total of 168 elderly patients with hepatitis B-related acute-on-chronic liver failure(HBV-ACLF)at Tianjin Third Central Hospital who met the diagnostic criteria of the Asian Pacific Association for the Study of the Liver(APASL)-ACLF were enrolled,176 non-elderly HBV-ACLF patients served as the control group during the same period,and their baseline and progression data were recorded.At the same time,the elderly group was divided into the progressive subgroup and the non-progressive subgroup based on the diagnostic criteria of the European Society for the Study of the Liver(EASL)-ACLF,and their baseline and progression data were recorded.Independent risk factors for HBV-ACLF progression in the elderly were analyzed using multivariate Cox proportional risk model regression.Results Compared with non-elderly patients with HBV-ACLF,elderly patients were more likely to progress to meet the EASL-ACLF diagnostic criteria and have higher mortality.Multivariate Cox proportional risk model regression analysis showed that baseline arterial lactic acid levels(HR=1.77,95%CI:1.36-2.30,P<0.01),secondary nosocomial infections(HR=13.90,95%CI:3.73-51.87,P<0.01),rates of change in maximum total bilirubin(HR=1.08,95%CI:1.01-1.15,P=0.04),rates of change in maximum MELD(HR=4.06,95%CI:1.53-10.77,P=0.01)and rates of change in maximum CLIF-SOFA(HR=12.74,95%CI:2.46-66.08,P<0.01)were independent risk factors for progression of HBV-ACLF in elderly patients.Conclusions Compared with non-elderly patients,elderly patients with HBV-ACLF have more advanced disease and higher mortality.Therefore,risk factors should be identified as soon as possible and treatment plans should be formulated as soon as possible to further reduce the mortality.