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Liver failure is a familiar clinical severe liver disease syndrome with a very high mortality rate. Over the years, scholars from around the world have been exploring the definition, etiology, classification, types, diagnosis and treatment, and prognostic judgment of liver failure. Reflecting changes, that have transpired in recent years at home and abroad relevant to clinical evidence, this guideline updates the information previously published by the Chinese Society of Infectious Diseases, Chinese Medical Association, Liver Failure and Artificial Liver Group, Severe Liver Diseases and Artificial Liver Group, Chinese Society of Hepatology, Guidelines for Diagnosis and Treatment of Liver Failure (2012 Edition).

Objective: To study the correlation between clinically detected serum galectin-3 levels and prognosis of liver failure., Methods: Fifty-five patients diagnosed with liver failure were administered a combined modality therapy and followed up until death or for 6 months. Fifty-five patients with liver failure were administered a combined modality therapy and followed up until death or for 6 months. In addition, 30 patients with chronic hepatitis B (CHB) and 30 healthy volunteers were matched for use as controls. Serum galectin-3 levels were detected at baseline and last follow-up visit and compared between groups by statistical analysis., Results: At baseline, the CHB group had a significantly higher level of serum galectin-3 than the healthy control group (F=2.701, P less than 0.01). However, the galectin-3 level 5 of the liver failure group was significantly higher than that of both the CHB group (F=8.121, P less than 0.01) and the healthy control group (F=11.231, P less than 0.01). When patients within the liver failure group were divided by survival and death occurring during the 6-month follow-up period, the patients who died (n=28) were found to have a significantly higher level of serum galectin-3 than the surviving patients (n=27) (P less than 0.01). The area under the curve of ROC curve is 0.766, and cut off value is 0.246 5 ng/ml., Conclusion: The level of serum galectin-3 is positively correlated with risk of death in patients with liver failure. Up-regulation of galectin-3 may act as a protective factor in patients with severe liver injury.

To analyze the characteristics of serum sodium in decompensated cirrhosis and evaluate the prognostic ability of the model for end-stage liver disease (MELD) in Na-containing models. Patients diagnosed with decompensated cirrhosis at our hospital were enrolled for study between June 2005 and October 2010. Patients were classified among three groups, according to serum sodium concentration: less than 125 mmol/L, 125 to 135 mmol/L, and more than 135 mmol/L. Mortality rates among the three groups were compared by Kaplan-Meier survival analysis. In addition, the different serum sodium concentrations were analyzed for correlations between Child-Pugh score and complication incidence rates of portal hypertension. The area under the receiver operating characteristic (ROC) curve (AUC) was used to compare the predictive abilities of MELD, MELD-Na, and the integrated (i) MELD scores for 3-month, 6-month and 1-year mortalities. A total of 467 patients were analyzed, and 50.54% had hyponatremia ( less than 135 mmol/L). Sodium concentration was correlated with mortality, and Kaplan-Meier survival analysis indicated that mortality was significantly higher in each subgroup with lower sodium concentration (all, P = 0.000). Likewise, sodium concentration decreased in conjunction with increased severity of decompensation, as classified by Child-Pugh scoring (sodium: A more than B more than C; mortality: A less than B less than C). With the exception of digestive tract bleeding, complication incidence rates of hepatic encephalopathy, ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome increased when sodium concentration decreased. For predicting 3-month mortality, the AUC scores of MELD were not significantly different from the MELD-Na and iMELD scores (P more than 0.05). For predicting 6-month and 1-year mortality, the AUC scores of MELD-Na and iMELD were significantly higher than those of MELD (P less than 0.05). Hyponatremia is correlated with mortality and complications in decompensated cirrhosis patients. Incorporation of Na into the MELD may enhance it's prognostic ability.

Objectives: To study the clinical characteristics of hepatic failure with aspergillosis., Methods: The data of hepatic failure patients with fungal infection hospitalized in our hospital form January 1985 to June 2006 were collected. This research mainly focused on the clinical characteristics of the patients co-infected with aspergillosis., Results: The occurrence of aspergillosis was 20.5% (104 cases) among 507 hepatic failure patients with fungal infection. Compared with other fungal infection in hepatic failure patients, the effective rate of antifungal therapy and the improvement rate of underlying disease were worse in patients with aspergillus infection (36.5% vs 57.8%, P = 0.000; 26.0% vs 36.7%, P = 0.049). Aspergillus fumigatus was the most common species among 108 fungal species. The species next to Aspergillus fumigatus were Aspergillus niger and Aspergillus flavus. The mainly infected organ was lung and its clinical manifestation was atypical. Liver function could be improved with effective anti-fungus therapy., Conclusions: Diagnosis and treatment of aspergillosis is difficult in hepatic failure patients co-infected with aspergillosis. Early and effective antifungal therapy is helpful to the recovery of liver function in the hepatic failure patients suspected with aspergillosis co-infection.

Objective: To investigate the relationship between the Model for End-Stage Liver Disease (MELD) with Child-Pugh scoring, and the prognosis of patients with decompensated liver cirrhosis., Methods: 110 patients with decompensated liver cirrhosis were graded with MELD formula and with Child-Pugh. The death rate was observed within three months., Results: 31 patients died within 3-months. The mortality of patients whose MELD scores were between 10 approximately 19, 20 approximately 29, and > or = 30 was higher than those with MELD < or = 9 (The mortality of those with MELD less than 9, 10 approximately 19, 20 approximately 29, or > or = 30 was 11.76%, 38.18%, 64.71%, 75.00% respectively). The mortality of patients whose MELD scores were > or = 18 was higher than those with MELD < 18 (The mortality of those with MELD < 18, MELD > or = 18 was 26.58%, 58.06% respectively. chi2 = 9.643). The mortality of Child A, B, C was 14.89%, 42.55%, 75% respectively., Conclusion: Both MELD and Child-Pugh scores can accurately predict the short-term prognosis of patients with decompensated liver cirrhosis.

Objective: To study the practical use of the model for end-stage liver disease (MELD) in clinics and to assess its validity in predicting the prognoses of patients with severe viral hepatitis and to determine the validity of the model by the concordance (c)-statistic which is equivalent to the area under the receiver operating characteristic (ROC) curve. Also, the optimal cutoff values of MELD to discriminate between deceased and surviving patients were calculated using ROC curves., Methods: 121 patients were divided into a plasma exchange (PE) group and a non-plasma exchange (non-PE) group, and they were graded with the MELD formula. The death rate was observed within three months., Results: 81 patients died within 3 months (35 cases in the PE group, 46 cases in the non-PE group). The mortality rates of patients in the PE group whose MELD scores were between 20 to 30 and 30 to 40 were 31.6% and 57.7% respectively, but in non-PE cases they were 67.6%, 81.3% respectively; there was a significant difference between the PE group and non-PE group. The mortality rates of patients whose MELD score was higher than 40 were 93.3% in the PE group and 100% in the non-PE group, however there was no significant difference between the two groups. The optimal cut-off values of MELD to predict the prognoses of patients were 30 in the PE group whose sensitivity, specificity and c-statistic were 80.0%, 52.0% and 0.777, but in the non-PE group they were 25, 82.6%, 86.7% and 0.869, respectively., Conclusions: This study suggests that MELD scores can serve as an index of the severity of the disease of patients with severe viral hepatitis, and that the mortality rates of the patients increase with the increase of their MELD scores. MELD can accurately predict the short-term prognoses of patients with severe viral hepatitis.