Prognostic value of combined detection of alpha-fetoprotein, plasma prothrombin activity, and serum prealbumin in acute-on-chronic liver failure.

Background: Acute-on-chronic liver failure (ACLF) is a liver disease based on chronic liver disease, which is significantly influenced by clinical treatment regimen and disease status, and despite the existence of multiple prognostic assessment indicators for ACLF, the overall sensitivity and accuracy are relatively low.

Aim: To investigate the prognostic value of the combined detection of alpha-fetoprotein (AFP), plasma prothrombin activity (PTA), and serum prealbumin (PA) in ACLF.

Methods: This retrospective study included 87 patients with ACLF admitted from February 2021 to February 2023 and categorized them into the survival ( = 47) and death ( = 40) groups according to their clinical outcomes 3 months posttreatment. All the participants underwent AFP, PTA, and PA level measurements upon admission. Baseline data, as well as AFP, PTA, and PA levels, were comparatively analyzed. Pearson correlation coefficients were utilized to analyze the correlations of AFP, PTA, and PA with different survival outcomes in patients with ACLF. Receiver operating characteristic (ROC) curves and areas under the curves were used to evaluate the predictive value of AFP, PTA, and PA for ACLF prognosis.

Results: AFP, PTA, and PA levels were markedly decreased in the death group than in the survival group ( < 0.05). Pearson analysis indicated a positive association of the AFP, PTA, and PA levels with the survival of patients with ACLF ( < 0.05). ROC curve analysis determined the sensitivity and specificity of the combined diagnosis at 91.24% and 100.00%, respectively, both of which were notably increased compared to the single-index diagnosis. The ROC of their combined diagnosis was 0.989, significantly surpassing 0.907, 0.849, and 0.853 of AFP, PTA, and PA, respectively. No statistically significant variance was determined in the sensitivity and specificity of the combined diagnosis the single detection ( > 0.05).

Conclusion: The combined detection of AFP, PTA, and PA levels demonstrates favorable diagnostic value for the short-term prognosis of patients with ACLF, featuring high sensitivity and specificity.