摘要目的:探讨慢加急性肝衰竭（ACLF）ABC分型的预后及最新终末期肝病模型（MELD）评分3.0和中国重型乙型病毒性肝炎研究小组（COSSH）最新COSSH-ACLF Ⅱ评分对ACLF预后评估价值。方法:对1 409例随访队列进行ABC分型，采用受试者操作特征曲线下面积（AUROC）分析和MELD、MELD 3.0、COSSH-Ⅱ及住院3 d后COSSH-Ⅱ评分（COSSH-II-3d），评估对患者360 d预后的预测能力，同时比较了对不同分型及不同病因ACLF预后预测的差异。结果:1 409例ACLF患者生存曲线显示，A型ACLF与B型、C型ACLF比较，差异有统计学意义，Log Rank（Mantel-Cox） χ2=80.133， P<0.01；A型与C型比较， χ2=76.198， P<0.01；B型与C型差异无统计学意义， χ2=3.717， P>0.05。AUROC分析MELD、MELD 3.0、COSSH-Ⅱ及COSSH-Ⅱ-3d AUROC［95%可信区间（ CI）］分别为0.644、0.655、0.817和0.839（ P值均<0.01）。COSSH-II对A型ACLF及HBV相关ACLF（HBV-ACLF）360 d预后有更好的预测能力，AUROC（95% CI）分别为0.877和0.881（ P值均<0.01）。而MELD3.0未显示出比MELD更好的预测能力。 结论:ACLF 的ABC分型与预后密切相关，COSSH-Ⅱ评分对A型ACLF及HBV-ACLF预后具有更高的预测能力，患者住院3d后COSSH-Ⅱ评分对预后有更好的评估价值，提示应当重视ACLF入院初期的救治。

abstractsObjective:To investigate the ABC prognostic classification and the updated version of Model for End-stage Liver Disease (MELD) score 3.0 and Chinese Group on the Study of Severe Hepatitis B ACLF Ⅱ score (COSSH-ACLF Ⅱ score) to evaluate the prognostic value in acute-on-chronic liver failure (ACLF).Methods:ABC classification was performed on a 1 409 follow-up cohorts. The area under the receiver operating characteristic curve (AUROC) was used to analyze MELD, MELD 3.0, COSSH-Ⅱ and COSSH-Ⅱ score after 3 days of hospitalization (COSSH-Ⅱ-3d). The prognostic predictive ability of patients were evaluated for 360 days, and the prediction differences of different classifications and different etiologies on the prognosis of ACLF were compared.Results:The survival curve of 1 409 cases with ACLF showed that the difference between class A, B, and C was statistically significant, Log Rank (Mantel-Cox) χ2=80.133, P<0.01. Compared with class A and C, χ2=76.198, P<0.01, the difference between class B and C, was not statistically significant χ2=3.717, P>0.05. AUROC [95% confidence interval (CI)] analyzed MELD, MELD 3.0, COSSH-Ⅱ and COSSH-Ⅱ-3d were 0.644, 0.655, 0.817 and 0.839, respectively ( P<0.01). COSSH-Ⅱ had better prognostic predictive ability with class A ACLF and HBV-related ACLF (HBV-ACLF) for 360-days, and AUROC (95% CI) were 0.877 and 0.881, respectively ( P<0.01), while MELD 3.0 prognostic predictive value was not better than MELD. Conclusion:ACLF prognosis is closely related to ABC classification. COSSH-Ⅱ score has a high predictive value for the prognostic evaluation of class A ACLF and HBV-ACLF. COSSH-Ⅱ score has a better prognostic evaluation value after 3 days of hospitalization, suggesting that attention should be paid to the treatment of ACLF in the early stage of admission.