Abstract: Objective To investigate the predictive value of COSSH-ACLF score combined with serum neutrophil/lymphocyte ratio (NLR) and alpha-fetoprotein (AFP) in the short-term prognosis of acute-on-chronic liver failure (ACLF) after artificial liver support therapy. Methods 260 patients with ACLF who successfully received artificial liver support therapy in our hospital from February 2020 to January 2022 were selected retrospectively as the treatment group. Based on whether the patients survived 90 days after treatment, the patients in the treatment group were subdivided into survival group (236 cases) and death group (24 cases). In addition, 260 volunteers who underwent physical examination in our hospital at the same time were selected as the control group. COSSH-ACLF score, NLR and AFP levels were recorded for further analysis. Multivariate logistics regression analysis was used to analyze the risk factors affecting the short-term prognosis of ACLF. ROC curve was used to evaluate the predictive value of COSSH-ACLF score, NLR and AFP on the short-term prognosis of ACLF after artificial liver support therapy. Results The scores of COSSH-ACLF, NLR and AFP in the treatment group were higher than those in the control group (P<0.05); COSSH ACLF score, NLR and AFP in the death group were higher than those in the survival group (P<0.05); The short-term prognosis of ACLF after artificial liver therapy was correlated with serum total bilirubin (TBil), creatinine (Cr), international normalized ratio (INR), MELD score, C-reactive protein (CRP), COSSH-ACLF score, NLR and AFP (P<0.05); Multivariate regression analysis showed that TBil, INR, COSSH-ACLF score, NLR, AFP were the risk factors for short-term prognosis of ACLF treated with artificial liver support therapy (P<0.05). ROC curve showed that the combined prediction of COSSH-ACLF score, NLR, and AFP for short-term prognosis of ACLF had an AUC of 0.877, which was greater than the AUC of individual predictions (P<0.05), and AUC of COSSH ACLF score, NLR, AFP were 0.733, 0.798, 0.794, respectively. Conclusion COSSH ACLF score, NLR and AFP are risk factors for short-term prognosis of patients with ACLF after artificial liver support therapy, and their combined detection has certain predictive value for short-term prognosis of patients with ACLF.

Key words: Artificial liver, Acute-on-chronic liver failure, COSSH-ACLF score, NLR, AFP, Short-term prognosis