Abstract: Objective To analysis the clinical characteristics and prognostic influencing factors of patients suffering from the hepatitis B-related acute-on-chronic liver failure complicated with hepatic encephalopathy.Methods Two hundred and thirty-four patients suffering from the hepatitis B virus related acute-on-chronic liver failure complicated with hepatic encephalopathy who were hospitalized in Guangzhou Eighth People’s Hospital, Guangzhou Medical University from January 2015 to December 2020 were enrolled in this study. They were divided into an improved group and a deteriorated/death group. The patients were retrospective analyzed with multiple logistic regression analysis for their clinical characteristics and prognostic influencing factors.Results There were statistically significant differences in the status of liver cirrhosis (with/without), the levels of total bilirubin, prothrombin time activity and serum sodium, the complication of peritonitis (with/without) between the patients of the improved group (71/33, 374.08±100.05 umol/L, 29.63±5.70 %, 135.75±6.46 mmol/L, and 49/55, respectively) and the deteriorated/death group (104/26, 410.55±136.41 umol/L, 23.82±10.87 %, 132.86±5.81 mmol/L, and 78/52, respectively) ( χ²/P=4.217 / 0.040, t/P=-2.357 / 0.019, t/P=5.258/0.000, t/P=3.592 / 0.000, χ²/P=3.865/0.049, respectively). whereas there was no significant difference in the prognosis of patients with or without artificial liver treatment (44/60 in the improved group, and 43/87 in the deteriorated/death group)(χ²/P=2.108/0.147 ). When compared the fatality rates of patients during hospitalization according to their phases of hepatic encephalopathy, there were significant differences among the patients with phases Ⅰ, Ⅱ, Ⅲ and Ⅳ encephalopathy (0, 3.41%, 12.31%, 65.91%, respectively)(χ²/P=94.291/0.000). With background of liver cirrhosis, significant abnormalities in the levels of total bilirubin, serum sodium and prothrombin time activity were independent risk factors for the prognosis of patients suffering from the hepatitis B related acute-on-chronic liver failure complicated with hepatic encephalopathy [OR(95%CI)=2.095(1.046-4.194), P=0.037; OR(95%CI)=1.003(1.000-1.005), P=0.039; OR(95%CI)= 0.911(0.867-0.958), P=0.000; OR(95%CI)= 0.921(0.888-0.955), P=0.000; respectively], and high serum sodium and high prothrombin time activity are the prognostic protective factors.Conclusion With liver cirrhosis background, significant abnormalities in total bilirubin, serum sodium and prothrombin time activity are the independent risk factors for the prognosis of patients suffering from the hepatitis B-related acute-on-chronic liver failure complicated with hepatic encephalopathy. Therefore, active interventions shoud be provided timely to patients with risk factors of poor prognosis for improving the successful rate of treatments.

Key words: Hepatitis B, Acute-on-chronic liver failure, Hepatic encephalopathy, Clinical features, Prognosis