THE ETIOLOGY OF CHRONIC LIVER DISEASE IS AN INDEPENDENT PROGNOSTIC FACTOR IN PATIENTS WITH ACUTELY DECOMPENSATED CHRONIC LIVER DISEASE

초록

Background: 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. Methods: 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. Primary outcome was 28-day liver transplantation free survival (TFS). Results: The VH group had lower ChildPugh, MELD, MELD-Na, CLIF-SOFA, 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 (Subgroup 1), multivariate analysis was conducted using the prognostic factors identified in the univariate analysis for 28-day TFS, revealing independent factors such as hepatic encephalopathy (HE), systemic inflammatory response syndrome, albumin, bilirubin, AST, and International normalized ratio (INR). After adjusting for independent factors, the prognosis of the VH group was significantly poorer than that of the ALD group (Hazard ratio (HR) 1.781, 95% confidence interval (CI) 1.276-2.486, P=0.001). In the subgroup analysis comparing the ALD and Combination groups (Subgroup 2), multivariate revealed independent factors such as HE, albumin, bilirubin, AST, and INR. After adjusting for independent factors in multivariate analysis, the combination group also exhibited a significantly poorer prognosis (HR, 2.07, 95% CI 1.156-3.077, P=0.014). The underlying CLD categories were adjusted by the prognostic scores. In subgroup 1, the VH group exhibited a poorer prognosis than the ALD group, following adjustment for Child-Pugh, CLIF-SOFA, and CLIF-C OF scores (all P<0.05). In Subgroup 2, the Combination group demonstrated a poorer prognosis than the ALD group, following adjustment for Child-Pugh, MELD, MELD-Na, CLIF-SOFA, and CLIF-C OF scores (all Ps<0.05). 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 would require different risk prediction methods.