Abstract: Objective To investigate the effects of cirrhosis and acute-on-chronic liver failure (ACLF) related complications on the prognosis of patietns with ACLF. Methods A total of 1409 patients with ACLF were enrolled and followed up. Kaplan Meier method and Cox regression were used to analyze the survival rates and risk factors among the groups. Spearman correlation analysis was used to investigate the correlation between the occurrence of complications and ACLF staging. Results The 28-day and 360-day survival rates of ACLF in the cirrhosis group were 57.93% and 24.96%, in the non-cirrhosis group were 81.74% and 66.88%, respectively (χ²=13.618, 58.631, P<0.001). The survival curve showed that the 360-day mortality of non-cirrhosis group was significantly higher than that of cirrhosis group [log rank (mantel Cox) χ²=113.090, P<0.001]. The number of complications was significantly associated with the prognosis of ACLF [log rank (mantel Cox) χ²=268.642, P<0.001]. Cox multivariate regression showed that cirrhosis and 3 or more complications were the independent risk factors for death in patients with ACLF [HR 1.817 (95%CI: 1.460-2.260), 1.753 (95%CI: 1.379-2.229), P<0.001]. The number of complications of patients with ACLF was positively correlated with the type of ACLF, ACLF stage and MELD-Na score (Correlation coefficients were 0.319, 0.340 and 0.472 respectively, P<0.001) and negatively correlated with the prothrombin time activity (Correlation coefficient was -0.358, P<0.001).Conclusion Cirrhosis and complications are the main risk factors affecting the prognosis of ACLF, with a negative correlation. The liver cirrhosis and severity of liver decompensation are the important risk factors for ACLF complications.

Key words: Acute-on-chronic liver failure, Cirrhosis, Complications, Prognosis