Abstract: Objective The aim of this study was to investigate the clinical feature and efficacy of different prognostic scoring models in patients with acute-on-chronic liver failure (ACLF) with different underlying liver diseases.Methods The clinical data of 192 patients with ACLF admitted to our hospital between January 2017 and December 2018 were retrospectively analyzed, and out of them, 54 patients had underlying liver disease of chronic hepatitis (group A), 87 had compensated liver cirrhosis (group B) and 51 had decompensated cirrhosis (group C). The Child-Pugh, the model for end-stage liver disease (MELD), the chronic liver failure research group of European society of liver diseases (EASL-CLIF) and Chinese group on the Study of Severe Hepatitis B (COSSH) were applied to predict the prognosis.Results There were no significant differences in gender, age and etiology between the three groups; there were also no significant differences between the three groups as respect to serum total bilirubin and prothrombin time international normalized ratio (INR, P >0.05); the incidence of ascites and bacterial infections in group C were 70.6% and 47.1%, significantly higher than 62.1% and 33.3% in group B or 40.7% and 22.2% in group A (P <0.05); the 28-day and 90-day survival rates in group A were 63.0% and 59.3%, not significantly different as compared to 69.0% and 57.5% in group B or 56.9% and 47.1% in group C (P >0.05); serum bilirubin, creatinine, INR and hepatic encephalopathy were the independent factors impacting the 90 d survival; the performance of MELD, CLIF-C ACLFs and COSSH-ACLFs models in predicting the short-term mortality of patients with ACLF was superior to Child-Pugh score, and the MELD score was the best.Conclusion The clinical features and complications of ACLF patients with different underlying liver diseases are significantly different, and the prognosis of them are also different, which might need long-term observation.

Key words: Acute-on-chronic liver failure, Clinical features, Prognosis