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CN 22-1108/R
Volume 37 Issue 1
Jan.  2021
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Article Navigation >  Journal of Clinical Hepatology  > 2021  >  37(1): 56-62

Influencing factors for the short-term prognosis of patients with HBV-related acute-on-chronic liver failure

DOI: 10.3969/j.issn.1001-5256.2021.01.012
  • a.

    Department of Infectious Disease, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China

  • b.

    Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, China

  • Received Date: 2020-05-24
  • Accepted Date: 2020-09-24
  • Published Date: 2021-01-20
    Abstract
  •   Objective  To investigate the influencing factors for the short-term prognosis of patients with HBV-related acute-on-chronic liver failure (HBV-ACLF).  Methods  Clinical data were collected from 240 HBV-ACLF patients without liver transplantation who were admitted To The Second Affiliated Hospital of Xi'an Jiaotong University from January 2009 to December 2019, and the patients were divided into groups according to survival on days 28 and 90 after admission (28-day survival group with 164 patients and 28-day death group with 76 patients; 90-day survival group with 140 patients and 90-day death group with 100 patients). The data collected included predisposing factors, liver function parameters, Model for End-Stage Liver Disease (MELD) score, MELD combined with serum sodium concentration (MELD-Na) score, and complications. The Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The receiver operating characteristic (ROC) curve was plotted to calculate the area under the ROC curve (AUC), and a multivariate logistic regression analysis was used to investigate the risk factors for the short-term prognosis of HBV-ACLF.  Results  The main predisposing factors of HBV-ACLF included spontaneous activation of HBV (55.6%) and HBV activation caused by the withdrawal of or resistance to nucleoside analogues (25.2%). There were significant differences in age, prothrombin time activity (PTA), neutrophil-lymphocyte ratio (NLR), serum sodium, MELD score, MELD-Na score, and total bilirubin (TBil) at baseline between the 28-day survival group and the 28-day death group (Z=-2.400, -6.015, -5.070, -5.103, -5.044, -7.430, and -6.637, all P < 0.05), and there were also significant differences in age, PTA, NLR, serum sodium, MELD score, MELD-Na, TBil, and cholesterol at baseline between the 90-day survival group and the 90-day death group (Z=-2.205, -7.728, -3.335, -4.015, -6.053, -7.908, -6.655, and -3.607, all P < 0.05). The multivariate logistic regression analysis showed that TBil > 260.20 mmol/L (odds ratio [OR]=4.572, 95% confidence interval [CI]: 1.321-15.823, P < 0.05), PTA < 24.8% (OR=8.934, 95%CI: 3.026-26.374, P < 0.05), NLR > 5.63 (OR=2.632, 95%CI: 1.126-6.152, P < 0.05), serum sodium < 130.8 mmol/L (OR=27.467, 95%CI: 6.113-123.423, P < 0.05), MELD score > 17.84 (OR=4.303, 95%CI: 1.048-17.663, P < 0.05), and MELD-Na score > 25.1 (OR=3.453, 95%CI: 1.614-7.387, P < 0.05) were independent risk factors for 28-day survival; TBil > 260.20 mmol/L (OR=5.148, 95%CI: 1.918-13.822, P < 0.05), PTA < 25.5% (OR=15.718, 95%CI: 5.161-47.866, P < 0.05), serum sodium < 135.3 mmol/L (OR=10.080, 95%CI: 3.244-31.323, P < 0.05), MELD score > 17.84 (OR=11.157, 95%CI: 2.580-48.254, P < 0.05), MELD-Na score > 25.1 (OR=4.391, 95%CI: 2.057-9.372, P < 0.05) were independent risk factors for 90-day survival. Among the 240 patients, 160 (66.7%) experienced infection within 90 days, among whom 140 had bacterial infection, 12 had viral infection, and 8 had fungal infection. The 160 patients with infection had a significantly higher 90-day mortality rate than the patients without infection (46.3% vs 32.5%, χ2=6.720, P=0.010). Of all 240 patients, 176 had ascites, 44 had pleural effusion, 36 had acute renal injury, 60 had hepatic encephalopathy, and 12 had gastrointestinal bleeding within 28 days, and there were significant differences in the proportion of patients with acute renal injury, grade Ⅲ-Ⅳ hepatic encephalopathy, or gastrointestinal bleeding between the 28-day survival group and the 28-day death group (χ2=64.088, 29.811, 7.797, all P < 0.05).  Conclusion  TBil, PTA, serum sodium, MELD score, and MELD-Na score at baseline are independent risk factors for the 28- and 90-day prognosis of HBV-ACLF. Liver inflammation and necrosis caused by HBV activation may be the initiating factor for ACLF, and infection, acute renal injury, hepatic encephalopathy, and gastrointestinal bleeding are the main complications affecting the prognosis of patients.

     

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    • References(23)
  • [1]
    JALAN R, MOREAU R, KAMATH PS, et al. Acute-on-chronic liver failure: A distinct clinical condition[J]. Semin Liver Dis, 2016, 36(2): 107-108. DOI: 10.1055/s-0036-1583287
    [2]
    Liver failure and artificial liver group, infectious diseases branch, Chinese Medical Association, Severe liver disease and artificial liver group, Hepatology branch, Chinese Medical Association. Guidelines for diagnosis and treatment of liver failure (2012 Edition)[J]. J Prac Hepatol, 2013, 16(3): 210-216. (in Chinese) DOI: 10.3969/j.issn.1672-5069.2013.03.007

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2012年版)[J]. 实用肝脏病杂志, 2013, 16(3): 210-216. DOI: 10.3969/j.issn.1672-5069.2013.03.007
    [3]
    PENG L, ZHOU XS, GAN JH, et al. Analysis of short-term prognostic factors in patients with hepatitis B virus-related liver failure[J]. World Chin J Dig, 2012, 20(28): 2732-2736. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XXHB201228026.htm

    彭蕾, 周学士, 甘建和, 等. 乙型肝炎肝衰竭短期预后的影响因素[J]. 世界华人消化杂志, 2012, 20(28): 2732-2736. https://www.cnki.com.cn/Article/CJFDTOTAL-XXHB201228026.htm
    [4]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2019.01.007

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007
    [5]
    ANGELI P, GINÈS P, WONG F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: Revised consensus recommendations of the International Club of Ascites[J]. J Hepatol, 2015, 62(4): 968-974. DOI: 10.1016/j.jhep.2014.12.029
    [6]
    BLEI AT, CÓRDOBA J, Practice Parameters Committee of the American College of Gastroenterology. Hepatic encephalopathy[J]. Am J Gastroenterol, 2001, 96(7): 1968-1976. DOI: 10.1111/j.1572-0241.2001.03964.x
    [7]
    CHANG ML, LIAW YF. Hepatitis B flares in chronic hepatitis B: Pathogenesis, natural course, and management[J]. J Hepatol, 2014, 61(6): 1407-1417. DOI: 10.1016/j.jhep.2014.08.033
    [8]
    ZHANG CM, LIU T, XING YC. Antiviral treatment of chronic acute liver failure caused by spontaneous reactivation of HBV immune response[J]. Prac J Med & Pharm, 2013, 30(6):556-558. (in Chinese) DOI: 10.3969/j.issn.1671-4008.2013.06.053

    张春梅, 刘涛, 辛艳春. HBV免疫反应自发再激活所致慢加急性肝衰竭的抗病毒治疗[J]. 实用医药杂志, 2013, 30(6): 556-558. DOI: 10.3969/j.issn.1671-4008.2013.06.053
    [9]
    GUO L, WANG D, OUYANG X, et al. Recent advances in HBV reactivation research[J]. Biomed Res Int, 2018, 2018: 2931402.
    [10]
    WU T, LI J, SHAO L, et al. Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure[J]. Gut, 2018, 67(12): 2181-2191. DOI: 10.1136/gutjnl-2017-314641
    [11]
    JALAN R, SALIBA F, PAVESI M, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure[J]. J Hepatol, 2014, 61(5): 1038-1047. DOI: 10.1016/j.jhep.2014.06.012
    [12]
    MIAO Q, LU ZJ, LIAO XR, et al. Neurotoxicity of bilirubin[J]. Clin J Med Offic, 2010, 38(4):669-672.(in Chinese) DOI: 10.3969/j.issn.1671-3826.2010.04.072

    苗青, 陆智杰, 缪雪蓉, 等. 胆红素的神经毒性[J]. 临床军医杂志, 2010, 38(4): 669-672. DOI: 10.3969/j.issn.1671-3826.2010.04.072
    [13]
    CAI XJ, SHEN Y, ZHU XH, et al. Application of integrated end-stage liver disease model in prognostic judgment and treatment of chronic acute liver failure[J/CD]. Chin J Exp Clin Infect Dis (Electronic Edition). 2018, 12(5): 446-452. (in Chinese)

    蔡晓娟, 沈毅, 朱晓红, 等. 整合终末期肝病模型在慢加急性肝功能衰竭预后判断及治疗中的应用[J/CD]. 中华实验和临床感染病杂志(电子版), 2018, 12(5): 446-452.
    [14]
    YANG B, WU YK, CHEN ZC, et al. The dynamic changes of AST, ALT, TBil and PT and their relationship with prognosis of acute-on-chronic hepatitis B liver failure[J]. J Clin Hepatol, 2012, 28(3): 205-208. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2012.03.012

    杨波, 吴元凯, 陈忠诚, 等. ALT、AST、TBil及PT变化趋势与慢加急性乙型肝炎肝衰竭预后的关系[J]. 临床肝胆病杂志, 2012, 28(3): 205-208. DOI: 10.3969/j.issn.1001-5256.2012.03.012
    [15]
    WIESNER RH, MCDIARMID SV, KAMATH PS, et al. MELD and PELD: Application of survival models to liver allocation[J]. Liver Transpl, 2001, 7(7): 567-580. DOI: 10.1053/jlts.2001.25879
    [16]
    AGIASOTELLI D, ALEXOPOULOU A, VASILIEVA L, et al. Evaluation of neutrophil/leukocyte ratio and organ failure score as predictors of reversibility and survival following an acute-on-chronic liver failure event[J]. Hepatol Res, 2016, 46(6): 514-520. DOI: 10.1111/hepr.12582
    [17]
    WU DJ, JIN L, GAO YF, et al. Value of neutrophil-lymphocyte ratio in evaluating the short-time prognosis of patients with acute-on-chronic liver failure[J]. J Clin Hepatol, 2018, 34(9): 1945-1949. (in Chinese) DOI: 10.3969/j.issn.1001-5256.2018.09.023

    吴杜娟, 金蕾, 郜玉峰, 等. 中性粒细胞与淋巴细胞比值对慢加急性肝衰竭患者短期预后的评估价值[J]. 临床肝胆病杂志, 2018, 34(9): 1945-1949. DOI: 10.3969/j.issn.1001-5256.2018.09.023
    [18]
    CÁRDENAS A, SOLÀ E, RODRÍGUEZ E, et al. Hyponatremia influences the outcome of patients with acute-on-chronic liver failure: an analysis of the CANONIC study[J]. Crit Care, 2014, 18(6): 700. DOI: 10.1186/s13054-014-0700-0
    [19]
    BIGGINS SW, KIM WR, TERRAULT NA, et al. Evidence-based incorporation of serum sodium concentration into MELD[J]. Gastroenterology, 2006, 130(6): 1652-1660. DOI: 10.1053/j.gastro.2006.02.010
    [20]
    LIANG D. Clinical analysis of 36 liver failure patients with nosocomial fungal infection[J]. China Tropical Medicine, 2015, 15(12):1510-1512. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-RDYX201512029.htm

    梁东. 肝衰竭并发医院内真菌感染36例临床分析[J]. 中国热带医学, 2015, 15(12): 1510-1512. https://www.cnki.com.cn/Article/CJFDTOTAL-RDYX201512029.htm
    [21]
    ROMERO-GÓMEZ M, MONTAGNESE S, JALAN R. Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure[J]. J Hepatol, 2015, 62(2): 437-447. DOI: 10.1016/j.jhep.2014.09.005
    [22]
    SU HB, LIU XY, CHEN J, et al. Analysis of risk factors for acute kidney injury in patients with acute on chronic liver failure complicated with spontaneous bacterial peritonitis[J]. Chin Hepatol, 2018, 23(10): 860-863.(in Chinese) DOI: 10.3969/j.issn.1008-1704.2018.10.007

    苏海滨, 刘晓燕, 陈婧, 等. ACLF合并SBP患者发生急性肾损伤的危险因素分析[J]. 肝脏, 2018, 23(10): 860-863. DOI: 10.3969/j.issn.1008-1704.2018.10.007
    [23]
    SUN WJ, CHEN DF. Diagnosis and treatment strategy of patients with liver failure and gastrointestinal bleeding[J]. J Prac Hepatol, 2014, 17(2): 202-205. (in Chinese) DOI: 10.3969/j.issn.1672-5069.2014.02.026

    孙文静, 陈东风. 肝衰竭并发消化道出血的诊断与治疗策略[J]. 实用肝脏病杂志, 2014, 17(2): 202-205. DOI: 10.3969/j.issn.1672-5069.2014.02.026
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