Abstract: Objective To explore the application value of thromboelastography (TEG) parameter, maximum amplitude (MA), in HBV-related acute-on-chronic liver failure (HBV-ACLF), and provide more evidence for optimizing the diagnosis and treatment strategy of ACLF. Methods Between January 2023 and June 2024, 53 patients with HBV-ACLF were admitted, 40 patients with chronic hepatitis B and 30 healthy people (control group) during the same period were included in the study. The coagulation indexes and TEG parameters of the three groups were compared. After a 90-day follow-up, the patients were divided into survival group and death group, and the clinical data of the two groups were compared. Cox regression analysis was used to find the factors affecting the clinical outcome of HBV-ACLF, and the prediction of the above factors on different clinical outcomes was analyzed by drawing the receiver operating characteristic (ROC) curve. Results The differences in INR, APTT, TT, FIB, R time, K time, α angle and MA among HBV-ACLF group, CHB group and control group were statistically significant (P<0.05). After a 90-day follow-up observation, there were 35 surviving and dead cases in HBV-ACLF group. Compared with the survival group, PLT, α-angle, MA and FIB in the dead group decreased significantly (P<0.05), while the scores of R time, K time, INR and MELD increased significantly (P<0.05). Univariate Cox regression analysis showed that PLT, INR, FIB, K-time, MA and MELD scores were related with the death of HBV-ACLF patients (P<0.05). The multivariate Cox regression analysis showed that INR and MA were independent predictors of the death of HBV-ACLF patients (P<0.05), with specific hazard ratios of 0.93 (95% CI: 0.84~0.97, P<0.05) and 3.11 (95% CI: 1.93~5.07, P<0.05). The value of MA and INR in predicting the death of HBV-ACLF patients was evaluated by drawing ROC curve. The diagnostic values (area under the curve, AUC) of MA and INR were 0.85 (95% CI: 0.77~0.93) and 0.77 (95% CI: 0.74~0.80), respectively. When they were combined, the diagnostic AUC value was 0.90 (95% CI: 0.82~0.97, P<0.05). Conclusion MA, as a dynamic index to evaluate the coagulation function of HBV-ACLF patients, has shown a important clinical value in predicting short-term clinical outcomes. By monitoring MA, the risk of bleeding and thrombosis in HBV-ACLF patients can be better identified, thus providing basis for individualized treatment and more comprehensive support for clinical decision-making.

Key words: HBV-related acute-on-chronic liver failure, Maximum amplitude of thromboelastogram, Cox regression analysis, Receiver operating characteristic curve