Abstract: Objective The aim of this study was to analyze the triggering factors and impacting factors of prognosis in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). Methods A retrospective analysis was performed on 96 patients with HBV-ACLF between January 2019 and December 2021, and all patients received comprehensive internal medicine supporting therapy at base of entevavir antiviral treatment. The patients were followed-up for 90 days. The univariate and multivariate Logistic regression analysis were applied to reveal the risk factors that impacted the prognosis. Results The triggering factors in our series included self-discontinuation of antiviral therapy in 53 cases (55.2%), hepatitis H or hepatitis E co-infection in 11 cases (11.4%), complicated bacterium infection in 9 cases (9.4%), exhausted in 7 case (7.3%), binge in 6 case (6.2%), drug-induced liver injuries in 5 cases (5.2%) and cryptogenic in 5 cases (5.2%); at the end of 90 day observation, 69 patients survived and 27 patients died; the median ages in dead patients was 50(41, 69)yr, significantly older than [39(33, 58) yr, P<0.05] in survived patients, the incidences of complication, such as gastrointestinal bleeding (GIB), hepatic encephalapathy (HE) and acute kidney injury (AKI), were 14.8%, 29.6% and 44.4%, significantly higher than 1.4%, 5.8% and 14.5% (P<0.05) in the survivals, and serum bilirubin level was 532(204, 780)μmol/L, significantly higher than [302(80, 416)μmol/L, P<0.05], the INR was 3.0(2.0, 3.4), significantly higher than [2.1(1.5, 2.6), P<0.05] and the MELD score was 26(18, 37), significantly higher than [20(10, 29), P<0.05] in the survivals; the multivariate Logistic regression analysis showed that the ages [OR=1.04(95%CI:1.02-1.08)], GIB[OR=1.51(95%CI:1.23-0.79)], HE [OR=0.50(95%CI:0.22-0.78)], INR[OR=1.52(95%CI:1.22-0.73)] and the MELD score [OR=2.44(95%CI:1.63-3.75)] were the independent risk factors for poor prognosis in patients with HBV-ACLF. Conclusion The predisposing factors of patients with HBV-ACLF mainly include inappropriate discontinuation of nucleos(t)ide , other heparnavirus infections and bacterial infections. The clinicians should take the risk factors ,such as elderly age, GIB, HE, and MELD scores into consideration and deal with them carefully to improve the prognosis.

Key words: Acute-on-chronic liver failure, Hepatitis B, Predisposing causes, Prognosis, Risk factors