Abstract: Objective To analyze the prognosis and influencing factors of bleeding events in patients with hepatitis B virus-associated acute on chronic liver failure (HBV-ACLF).Methods One hundred and fifty-six patients with HBV-ACLF (119 males and 37 females) with an average age of (49.2±10.3) years were collected in this study From January 2017 to January 2021. Within them, 51 cases suffered from bleeding events (bleeding group) and 104 cases weren’t bleeding (non-bleeding group). Clinical data of these two groups of patients were compared. Measurement data were analyzed with T test. Counting data were analyzed with Chi-square test. The survival rates were compared by Log-Rank test.Results There were 31 cases (60.8%) of liver cirrhosis in the bleeding group and 36 cases (34.3%) of liver cirrhosis in the non-bleeding group, and the difference was statistically significant (P<0.05). Creatinine (Cr) and platelet (PLT) in the bleeding group were (80.6±9.8) mol/L and (70.5±12.4)×10⁹/L, respectively, which were significantly higher than those in the non-bleeding group [(62.4±8.4) mol/L and (102.5±22.7)×10⁹/L, P<0.05]. The fibrinogen, coagulation factors V, VII and VIII in the bleeding group were (1.1±0.2) g/L, (31.6±8.7)%, (32.8±9.2)% and (192.4±32.7)%, respectively, which were significantly higher than those in the non-bleeding group [(1.8±0.6) g/L, (64.8±14.7)%、(84.4±13.8)% and (118.0±26.1)%, respectively, P<0.05]. All patients were followed up effectively for 3 months, and the end-point of follow-up was HBV-ACLF related death. The 1-month survival rates of the bleeding group and the non-bleeding group were 84.3%(43/51) and 93.3%(98/105), respectively, without significant difference (P>0.05). The 3-month survival rates of the bleeding group and the non-bleeding group were 51.0%(26/51) and 73.3%(77/105), respectively, and the difference was statistically significant (P<0.05). After 3 months’ follow-up, 103 cases of HBV-ACLF patients survived (survival group) and 53 cases died (death group). Comparing the complications between these two groups, there were significant differences in hepatic encephalopathy, hepatorenal syndrome, electrolyte disturbance and various complications (P<0.05).Conclusion In HBV-ACLF patients, liver cirrhosis, decreased fibrinogen level and decreased coagulation factor VII activity are related to an increased risk of bleeding, which affect the prognosis of the patients. The occurrences of hepatic encephalopathy, hepatorenal syndrome, electrolyte disturbance and various complications during treatment indicated a poor prognosis.

Key words: Hepatitis B virus, Acute-on-chronic liver failure, Liver cirrhosis, Fibrinogen