关键词: 慢加急性肝衰竭, 血小板聚集功能, 总胆红素, 直接胆红素, 预后

Abstract: Objective To explore the impact of platelet aggregation function on the prognosis of patients with acute-on-chronic liver failure (ACLF). Methods A retrospective case cohort study was conducted in 120 ACLF patients admitted to Shuguang Hospital affiliated to Shanghai University of Traditional Chinese Medicine from July 2022 to July 2024. Based on their 28 day survival status after admission, they were divided into a mortality group (n=60) and a survival group (n=60). All patients were tested for platelet aggregation function upon admission, and other baseline data were collected at the same time. Univariate and multivariate logistic regression models were used to analyze the factors affecting the prognosis of these ACLF patients, and receiver operating characteristic (ROC) curves were drawn to analyze the predictive power of platelet aggregation function for the prognosis of ACLF patients. Results The neutrophil to lymphocyte ratio (NLR), direct bilirubin (DBil), and total bilirubin (TBil) levels in the mortality group were (3.42±0.21), (179.62±11.05) μmol/L, and (320.02±20.14) μmol/L, respectively, which were higher than those of (3.21±0.17), (169.33±8.61) μmol/L, and (304.25±18.66) μmol/L in the survival group. The levels of platelet aggregation rate (PAR)-adrenaline (A), PAR collagen (COL), and PAR adenosine diphosphate (ADP) were (40.9±3.91)%, (28.64±3.27)%, and (30.22±3.75)%, respectively, which were lower than those of [(46.50±4.83)%, (33.52±3.41)%, and (35.30±3.15)% in the survival group, and the difference was statistically significant (P<0.05). The comparison of other baseline data showed no statistical significant difference (P>0.05). By multivariate logistic regression analysis it was shown that PAR-A, PAR-COL, PAR-ADP, and DBil were prognostic factors for ACLF patients [OR (95% CI)=0.704 (0.555~0.894), 0.523 (0.367~0.745), 0.595 (0.440~0.805), and 1.120 (1.011~1.241), P<0.05]. The ROC curve analysis showed that PAR-A, PAR-COL, and PAR-ADP had moderate predictive value for the prognosis of ACLF patients, with areas under the curve (AUC) of 0.816, 0.842, and 0.848, respectively. The combination of these three factors had high predictive value for the prognosis of ACLF patients, with AUC of 0.968. Conclusion The levels of PAR-A, PAR-COL, and PAR-ADP are influencing factors for the prognosis of ACLF patients, and the detection of platelet aggregation function is helpful in predicting patients′ prognosis, which has certain clinical guiding significance.

Key words: Acute-on-chronic liver failure, Platelet aggregation function, Total bilirubin, Direct bilirubin, Prognosis