Clinical characteristics and prognosis of patients with HBV-ACLF versus ALD-ACLF: a retrospective comparative study

Objective This study aims to investigate the differences in clinical characteristics and prognosis between patients with HBV-ACLF (Hepatitis B Virus-related Acute-on-Chronic Liver Failure) and those with ALD-ACLF (Alcohol-Associated Acute-on-Chronic Liver Failure), and to identify risk factors associated with 90-day mortality in both cohorts. Methods This study enrolled 56 patients with HBV-ACLF and 83 patients with ALD-ACLF to compare their clinical characteristics and conduct analyses of risk factors associated with 90-day prognosis. Result Compared with the HBV-ACLF cohort, the ALD-ACLF group exhibited a higher proportion of male patients and a greater prevalence of ascites. Additionally, significant differences were observed in laboratory parameters, with ALD-ACLF patients showing higher levels of WBC (white blood cells), N (neutrophils), and M (monocytes) but lower levels of ALT (alanine aminotransferase), AST (aspartate aminotransferase), ALB (albumin), K (potassium), and Na (sodium) compared to HBV-ACLF patients ( p < 0.05). In terms of prognostic factors, TBIL (total bilirubin) and PT (prothrombin time) were identified as independent risk factors for 90-day mortality in HBV-ACLF patients, while WBC, TBIL, and PT were associated with 90-day mortality in ALD-ACLF patients. Conclusion Patients with ALD-ACLF typically present with a higher prevalence of comorbidities, such as ascites and infections, compared to those with HBV-ACLF. However, no significant differences in prognosis were observed between the two cohorts. For HBV-ACLF patients, elevated TBIL and prolonged PT were identified as independent risk factors for 90-day mortality. In contrast, in addition to TBIL and PT, elevated white WBC was also associated with 90-day mortality in ALD-ACLF patients. These findings warrant further validation through multicenter studies with larger sample sizes.