The etiology of chronic liver disease is an independent prognostic factor in patients with acutely deteriorated chronic liver disease

초록

Background and aims: The prognosis for patients with acutely decompensated chronic liver disease (CLD) is very poor. There is a lack of research on the prognostic impact of underlying CLD in patients with acutely decompensated CLD. Method: We enrolled a total of 1,352 patients, categorized into three groups: those with viral hepatitis (VH) (n = 206), alcoholic liver disease (ALD) (n = 1,017), and a combination of alcohol and viral hepatitis (Combination) (n = 129) based on etiology of underlying CLD. Subgroups analysis were conducted using Propensity Score matching (PSM). Primary outcome was 28-day liver transplantation free survival (TFS). Results: The VH group had lower Child-Pugh, MELD, MELD-Na, CLIFSOFA, and CLIF-C OF scores compared to the ALD and Combination groups, while the ALD and Combination groups had similar scores. The 28-day TFS was similar between the VH and ALD groups (P = 0.661), but significantly lower in the Combination group compared to other groups (P < 0.05). In the subgroup analysis comparing the VH and ALD groups after PSM (Subgroup 1), VH group (n = 193) had significantly lower 28-day TFS than ALD group (n = 197) (P = 0.01). In the subgroup analysis comparing the VH and Combination groups after PSM (Subgroup 2), there was no significant difference in 28-day TFS between VH group (n = 132) and Combination group (n = 90) (P = 0.7). In the subgroup analysis comparing the ALD and Combination groups after PSM (Subgroup 3), ALD group (n = 234) had significantly higher 28-day TFS than Combination group (n = 120) (P = 0.04). When comparing patients with a precipitating event of excessive alcohol consumption in the ALD group (n = 640) to patients with a precipitating event of hepatitis virus in the VH group (n = 52), there was no difference in 28-day TFS between the two groups (P = 1.0). However, after PSM, the patients with a precipitating event of hepatitis virus (n = 32) had significantly lower 28-day TFS than the patients with a precipitating event of excessive alcohol consumption (n = 35) (P = 0.04). Conclusion: Patients with VH as the etiology of underlying CLD exhibit a poorer prognosis compared to those with ALD. Furthermore, the combined ALD and VH group also demonstrates a worse prognosis than the ALD-only group. Thus, different etiologies require different risk prediction methods.