关键词: 慢加急性肝衰竭, 营养风险筛查, 营养不良, 预后

Abstract: Objective To explore the prognostic value of nutritional risk screening (NRS) scores in patients with acute-on-chronic liver failure (ACLF), and to guide nutritional interventions for ACLF patients. Methods The clinical data of 228 ACLF patients treated at the Third People′s Hospital of Nantong from August 2021 to August 2023 were collected. Patients were divided into a survival and a death groups based on 90-day survival status post-admission. The correlation between NRS scores and Child-Turcotte-Pugh (CTP) scores, Model for End-Stage Liver Disease (MELD) series scores was analyzed; receiver operating characteristic (ROC) curves were used to assess the diagnostic efficacy of NRS scores compared to CTP and MELD series scores; Kaplan-Meier method was employed to plot survival curves. Results There were no statistically significant differences in age, gender, complications, ALT, AST, renal function, and blood routine between the two groups (P>0.05). The BMI, Alb, and prothrombin activity in the survival group were 21.30(20.90,22.23) kg/m², (30.6±4.02)g/L, and 28.21(23.96,32.35)%, respectively. The BMI, Alb, and prothrombin activity in the death group were 19.27(18.59, 19.94)kg/m², (27.18±3.26)g/L, and 21.85 (17.60,25.73)%, respectively. There were significant differences between the two groups (P<0.05). The TBil, NRS score, CTP score, MELD score, MELD-Na score, and iMELD score in the death group were 335.55 (246.25, 431.08)μmol/L, 4.00 (4.00, 5.00), 10.00 (9.00,11.00), 23.02 (20.85, 25.86), 27.02 (22.71, 34.05), and 49.83±7.25, respectively. The TBIL, NRS score, CTP score, MELD score, MELD-Na score, and iMELD score in the improvement group were 225.20 (185.68, 288.45)μmol/L, 2.00 (2.00,3.00), 9.00 (8.00,10.00), 19.67(17.62,22.88), 21.42 (18.16, 27.43), and 43.66 ±7.52, respectively. There were significant differences between the two groups (P<0.05). Pearson correlation analysis revealed a positive correlation between NRS scores and CTP scores(r=0.399,P<0.05), MELD scores(r=0.301,P<0.05), MELD-Na scores(r=0.234,P<0.05), and iMELD scores(r=0.302,P<0.05). ROC curve analysis showed that the area under the curve (AUC) for NRS scores(0.896)was superior to that of MELD scores(0.707), MELD-Na scores(0.688), iMELD scores(0.735), and CTP scores(0.669)(all P<0.05). Kaplan-Meier analysis indicated that ACLF patients with NRS scores≥3 [37.01% (47/127)] had significantly lower cumulative survival rates than those with NRS scores＜3[91.09％(92/101)](P<0.0001). Conclusion NRS scores are correlated with the prognosis of ACLF patients, and patients with NRS scores ≥ 3 (high nutritional risk group) have poorer outcomes. Early nutritional risk assessment and appropriate interventions can help to improve patients′ prognosis.

Key words: Acute-on-chronic liver failure, Nutritional risk screening, Malnutrition, Prognosis