To research the predictive value of AIMS65 score, Child-Pugh score, model for end-stage liver disease (MELD) score combined with coagulation indices in identifying acute-on-chronic liver failure (ACLF) among patients with cirrhosis.

The study was a retrospective cohort study, 247 patients with liver cirrhosis admitted to Yan'an University Affiliated Hospital from August 2019 to July 2024 were selected as the research objects, among which 44 patients were excluded because they did not meet the inclusion criteria, and finally 203 patients were enrolled. The basic demographic characteristics, medical history, laboratory indicators such as coagulation function and the scores of AIMS 65, Child-Pugh and MELD were collected and analyzed. Through univariate analysis and multivariate Logistic regression analysis, the influencing factors of ACLF in patients with liver cirrhosis were clarified. The receiver operating characteristic (ROC) curve was drawn for each scoring indicator and the combined detection in the diagnosis of liver cirrhosis complicated with ACLF, and the area under the curve (AUC) was calculated. The diagnostic efficacy of each scoring index and joint detection in the diagnosis of liver cirrhosis complicated with ACLF was evaluated.

Among the 203 patients, 47 cases developed ACLF (the ACLF group), while 156 cases did not have ACLF (the non-ACLF group). The levels of Child-Pugh grade, AIMS65 score, MELD score, alanine aminotransferase, aspartate aminotransferase, total bilirubin, prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) in ACLF group were significantly higher than those in non-ACLF group, while the levels of albumin and fibrinogen (FIB) were significantly lower than those in non-ACLF group (P<0.05). Multivariate Logistic regression analysis showed that Child-Pugh grade, AIMS65 score, MELD score, PT, APTT and TT were independent risk factors (P<0.05), while FIB was a protective factor (P<0.05). In the diagnosis of liver cirrhosis complicated with ACLF, the AUC of the combined diagnosis of Child-Pugh score, AIMS65 score, MELD score and coagulation test was 0.847, which was significantly higher than that of the single detection of each scoring index (P<0.05). The combined prediction model showed good prediction efficiency in viral hepatitis, alcoholic liver disease and metabolic-related fatty liver disease. DeLong test showed that there was no significant difference in AUC among the three groups (viral vs. alcoholic: P=0.712; viral vs. metabolic correlation: P=0.802; alcoholic vs. metabolic correlation: P=0.915).

AIMS65 score, Child-Pugh score and MELD score combined with coagulation test indexes can effectively predict the risk of patients with liver cirrhosis complicated with ACLF, which is helpful for the clinical implementation of timely intervention measures and improving the prognosis of patients.