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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 37 Issue 12
Dec.  2021
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Article Contents

Risk factors for liver cirrhosis in acute-on-chronic liver failure patients without liver cirrhosis in the convalescence stage

DOI: 10.3969/j.issn.1001-5256.2021.12.019
Research funding:

Chinese Foundation for Hepatitis Prevention and Control-TianQing Liver Disease Research Fund Subject (TQGB20210013);

National Key R&D Program of China (2017YFA0103000)

  • Received Date: 2021-04-25
  • Accepted Date: 2021-05-21
  • Published Date: 2021-12-20
  •   Objective  To investigate the risk factors for liver cirrhosis after hepatocyte necrosis in acute-on-chronic liver failure (ACLF) patients without liver cirrhosis in the convalescence stage.  Methods  A retrospective analysis was performed for the clinical data of ACLF patients who were treated in Beijing YouAn Hospital, Capital Medical University, from January 2015 to June 2019. A total of 57 ACLF patients without liver cirrhosis who had a survival time of > 48 weeks and complete clinical data were enrolled, and according to the presence or absence of liver cirrhosis at week 48 of follow-up, they were divided into non-cirrhosis group and cirrhosis group. The two groups were compared in terms of clinical indices, noninvasive liver fibrosis scores, and prognostic scores to screen out independent influencing factors for progression to liver cirrhosis. The t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups. Univariate and multivariate logistic analyses were used to investigate the risk factors for progression to liver cirrhosis within 48 weeks, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive efficiency of independent risk factors.  Results  Among the 57 patients, 9(15.8%) developed liver cirrhosis within 4 weeks of follow-up and showed disappearance of liver cirrhosis at week 48 of follow-up; at week 48 of follow-up, 26 patients (45.6%) developed liver cirrhosis, and the patients were divided into non-cirrhosis group with 31 patients and cirrhosis group with 26 patients. Compared with the non-cirrhosis group, the cirrhosis group had significantly lower levels of cholinesterase (ChE) (2844.32±961.05 U/L vs 4137.59±1604.83 U/L, t=3.177, P=0.003) and platelet count (PLT) [(100.04±57.28)×109/L vs (138.84±56.46)×109/L, t=2.564, P=0.013] and a significantly higher fibrosis-4 score [7.81 (3.92-11.36) vs 4.45 (2.14-7.80), Z=258.0, P=0.030]. The above indices were included in the univariate and multivariate logistic analyses, and the results showed that low levels of ChE (odds ratio [OR]=1.001, 95% confidence interval [CI]: 1.000-1.002, P=0.010) and PLT(OR=1.015, 95%CI: 1.002-1.028, P=0.027) were independent risk factors for liver cirrhosis in ACLF patients without liver cirrhosis in the convalescence stage. The ROC curve analysis showed that the combination of ChE and PLT had a greater value in predicting the onset of liver cirrhosis in ACLF patients without liver cirrhosis in the convalescence stage.  Conclusion  Low levels of ChE and PLT are independent risk factors for liver cirrhosis in ACLF patients without liver cirrhosis in the convalescence stage, and the combination of ChE and PLT has certain advantages.

     

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  • [1]
    SHI Y, YANG Y, HU Y, et al. Acute-on-chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults[J]. Hepatology, 2015, 62(1): 232-242. DOI: 10.1002/hep.27795.
    [2]
    SARIN SK, CHOUDHURY A, SHARMA MK, et al. Acute-on-chronic liver failure: Consensus recommendations of the Asian Pacific association for the study of the liver (APASL): An update[J]. Hepatol Int, 2019, 13(4): 353-390. DOI: 10.1007/s12072-019-09946-3.
    [3]
    Liver Failure and ArtificiaI Liver Group, Chinese Society of Infeclious Diseases, Chinese MedicaI Association; Severe Liver Disease and Artificial Liver Group, Chinses Society of Hepatology, Chinese MedicaI Association. Guideline for diagnosis and treatment of liver failure (2018)[J]. J Clin Hepatol, 2019, 35(1): 38-44. 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.
    [4]
    ZHANG MG, XING DW, HUANG XJ, et al. A study on correlation between ct grouping of liver cirrhosis and clinically hepatic functional reserve[J]. J Hepatobiliary Surg, 2009, 17(1): 40-42. DOI: 10.3969/j.issn.1006-4761.2009.01.016.

    张闽光, 邢东炜, 黄学菁, 等. 肝硬化CT类型与临床肝储备功能相关性研究[J]. 肝胆外科杂志, 2009, 17(1): 40-42. DOI: 10.3969/j.issn.1006-4761.2009.01.016.
    [5]
    ZHOU XS, QIU YW, SU TT, et al. Analysis of risk factors of cirrhosis after hepatitis necrosis in patients with chronic and acute liver failure[C]. The 10th National Conference on knotty and severe liver Diseasesm, 2019: 205-206.

    周学士, 邱源旺, 苏婷婷, 等. 慢加急性肝衰竭患者发生肝炎坏死后肝硬化的危险因素分析[C]. 第十届全国疑难及重症肝病大会, 2019: 205-206.
    [6]
    CUI SY, LIU L, ZHANG HX, et al. CT findings and clinical analysis of patients with acute on chronic liver failure due to hepatitis B cirrhosis[J]. J Hebei Med Univ, 2017, 38(7): 838-840. DOI: 10.3969/j.issn.1007-3205.2017.07.024.

    崔书彦, 刘莲, 张红霞, 等. 乙型肝炎、肝硬化所致慢加急性肝衰竭患者的CT表现与临床分析[J]. 河北医科大学学报, 2017, 38(7): 838-840. DOI: 10.3969/j.issn.1007-3205. 2017.07.024.
    [7]
    GUO HY, XU SC, LIAO M, et al. Liver stiffness for evaluating change of condition in patients with acute-on-chronic liver failure[J]. J Sun Yat-Sen Univ(Medical Sciences), 2019, 40(5): 723-730. DOI: 10.13471/j.cnki.j.sun.yat-sen. univ(med.sci).

    郭欢仪, 徐士丞, 廖梅, 等. 二维剪切波弹性成像肝硬度值评估慢加急性肝衰竭患者病情变化[J]. 中山大学学报(医学科学版), 2019, 40(5): 723-730. DOI: 10.13471/j.cnki.j.sun.yat-sen. univ(med.sci).
    [8]
    KONG J, XIANG XX. Value of serum cholinesterase in diagnosis/treatment and prognostic evaluation of liver diseases[J]. J Clin Hepatol, 2017, 33(9): 1806-1809. DOI: 10.3969/j.issn.1001-5256.2017.09.040.

    孔剑, 向晓星. 血清胆碱酯酶在肝病诊疗及转归中的应用价值[J]. 临床肝胆病杂志, 2017, 33(9): 1806-1809. DOI: 10.3969/j.issn.1001-5256.2017.09.040.
    [9]
    LONG ZR, YANG LY. Clinical value of detection of serum cholinesterase in Child-Pugh classification of the patients with cirrhosis[J]. Lab Med Clin, 2009, 6(24): 2113-2114. DOI: 10.3969/j.issn.1672-9455.2009.24.018.

    龙峥嵘, 杨良勇. 血清胆碱酯酶活性测定对肝硬化Child-Pugh分级的临床价值[J]. 检验医学与临床, 2009, 6(24): 2113-2114. DOI: 10.3969/j.issn.1672-9455.2009.24.018.
    [10]
    LIU D, LI J, LU W, et al. Gamma-glutamyl transpeptidase to cholinesterase and platelet ratio in predicting significant liver fibrosis and cirrhosis of chronic hepatitis B[J]. Clin Microbiol Infect, 2019, 25(4): 514. e1-514. e8. DOI: 10.1016/j.cmi.2018.06.002.
    [11]
    WU D, RAO Q, CHEN W, et al. Development and validation of a novel score for fibrosis staging in patients with chronic hepatitis B[J]. Liver Int, 2018, 38(11): 1930-1939. DOI: 10.1111/liv.13756.
    [12]
    CHAUHAN A, ADAMS DH, WATSON SP, et al. Platelets: No longer bystanders in liver disease[J]. Hepatology, 2016, 64(5): 1774-1784. DOI: 10.1002/hep.28526.
    [13]
    VASINA EM, CAUWENBERGHS S, FEIJGE MA, et al. Microparticles from apoptotic platelets promote resident macrophage differentiation[J]. Cell Death Dis, 2011, 2(9): e211. DOI: 10.1038/cddis.2011.94.
    [14]
    DELEVE LD. Liver sinusoidal endothelial cells and liver regeneration[J]. J Clin Invest, 2013, 123(5): 1861-1866. DOI: 10.1172/JCI66025.
    [15]
    KODAMA T, TAKEHARA T, HIKITA H, et al. Thrombocytopenia exacerbates cholestasis-induced liver fibrosis in mice[J]. Gastroenterology, 2010, 138(7): 2487-2498, 2498. e1-7. DOI: 10.1053/j.gastro.2010.02.054.
    [16]
    HERNANDEZ-GEA V, FRIEDMAN SL. Platelets arrive at the scene of fibrosis……studies[J]. J Hepatol, 2011, 54(5): 1063-1065. DOI: 10.1016/j.jhep.2010.10.045.
    [17]
    WATANABE M, MURATA S, HASHIMOTO I, et al. Platelets contribute to the reduction of liver fibrosis in mice[J]. J Gastroenterol Hepatol, 2009, 24(1): 78-89. DOI: 10.1111/j.1440-1746.2008.05497.x.
    [18]
    TAKAHASHI K, MURATA S, FUKUNAGA K, et al. Human platelets inhibit liver fibrosis in severe combined immunodeficiency mice[J]. World J Gastroenterol, 2013, 19(32): 5250-5260. DOI: 10.3748/wjg.v19.i32.5250.
    [19]
    WAI CT, GREENSON JK, FONTANA RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C[J]. Hepatology, 2003, 38(2): 518-526. DOI: 10.1053/jhep.2003.50346.
    [20]
    STERLING RK, LISSEN E, CLUMECK N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection[J]. Hepatology, 2006, 43(6): 1317-1325. DOI: 10.1002/hep.21178.
    [21]
    LEMOINE M, SHIMAKAWA Y, NAYAGAM S, et al. The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa[J]. Gut, 2016, 65(8): 1369-1376. DOI: 10.1136/gutjnl-2015-309260.
    [22]
    CHEN YP, HU XM, LIANG XE, et al. Stepwise application of fibrosis index based on four factors, red cell distribution width-platelet ratio, and aspartate aminotransferase-platelet ratio for compensated hepatitis B fibrosis detection[J]. J Gastroenterol Hepatol, 2018, 33(1): 256-263. DOI: 10.1111/jgh.13811.
    [23]
    LI Q, LU C, LI W, et al. Globulin-platelet model predicts significant fibrosis and cirrhosis in CHB patients with high HBV DNA and mildly elevated alanine transaminase levels[J]. Clin Exp Med, 2018, 18(1): 71-78. DOI: 10.1007/s10238-017-0472-3.
    [24]
    OKAJIMA A, SUMIDA Y, TAKETANI H, et al. Liver stiffness measurement to platelet ratio index predicts the stage of liver fibrosis in non-alcoholic fatty liver disease[J]. Hepatol Res, 2017, 47(8): 721-730. DOI: 10.1111/hepr.12793.
    [25]
    BERGER A, RAVAIOLI F, FARCAU O, et al. Including ratio of platelets to liver stiffness improves accuracy of screening for esophageal varices that require treatment[J]. Clin Gastroenterol Hepatol, 2021, 19(4): 777-787. e17. DOI: 10.1016/j.cgh.2020.06.022.
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