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Volume 38 Issue 5
May  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(5): 1048-1052

Determination of a reasonable threshold of total bilirubin for the diagnosis of hepatitis B virus-associated acute-on-chronic liver failure

DOI: 10.3969/j.issn.1001-5256.2022.05.014
  • 1.

    Peking University 302 Clinical Medical School, Beijing 100039, China

  • 2.

    Chinese PLA Medical School, Beijing 100853, China

  • 3.

    Senior Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China

Research funding:

The Capital's Funds for Health Improvement and Research, China (2020-1-5031)

More Information
  • Corresponding author: HU Jinhua, 13910020608@163.com(ORCID: 0000-0002-0647-9898)
  • Received Date: 2021-11-04
  • Accepted Date: 2022-01-11
  • Published Date: 2022-05-20
    Abstract
  •   Objective  To investigate a reasonable threshold of total bilirubin for the diagnosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), and to realize accurate early diagnosis.  Methods  A retrospective analysis was performed for the clinical data of 1232 patients with HBV-ACLF who were admitted to The Fifth Medical Center of Chinese PLA General Hospital from September 2008 to September 2018, and according to the baseline serum level of total bilirubin (TBil), the patients were divided into group A (TBil < 205.2 μmol/L) and group B (TBil ≥205.2 μmol/L). the two groups were compared in terms of clinical features and 28-day, 90-day, 1-year, and 3-year survival. The t-test or the Mann-Whitney U rank sum 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 Kaplan-Meier method was used to analyze survival rate, and the log-rank test was used for comparison.  Results  There were significant differences between the two groups in age(t=3.188, P=0.001) male sex(χ2=33.833, P < 0.001), liver failure classification(χ2=39.987, P < 0.001), white blood cell count(Z=6.586, P < 0.001), hemoglobin(Z=4.272, P < 0.001), platelet count(Z=3.680, P < 0.001), creatinine(Z=4.505, P < 0.001), total cholesterol(Z=8.644, P < 0.001), Na(Z=2.335, P=0.020), albumin(Z=2.592, P=0.010), HBV DNA(Z=3.703, P < 0.001), Model for End-Stage Liver Disease score(Z=11.828, P < 0.001), and MELD-Na score(Z=8.410, P < 0.001). At baseline, there were significant differences in the incidence rates of ascites and gastrointestinal bleeding between the two groups (χ2=12.036、4.342, P < 0.05). Infection was the most common new-onset complication within 28 days, followed by hepatic encephalopathy, and there was a significant difference in the incidence rate of infection between the two groups (χ2=5.294, P < 0.05). The 28-day transplant-free mortality rate was 21.2% in group A and 29.5% in group B(HR=1.473[95%CI: 1.151~1.886], P=0.005), which was consistent with the clinical feature of a high short-term mortality rate (> 15%) in patients with acute-on-chronic liver failure (ACLF). Although there was a difference in long-term mortality rate between the two groups, there was no significant increase in transplant-free mortality rate after 90 days in either group.  Conclusion  Under the premise of international normalized ratio ≥1.5, it is not recommended to increase the threshold of TBil to 205.2 μmol/L in the diagnostic criteria for HBV-ACLF, so as to ensure the early diagnosis of more ACLF patients and bring more opportunities for treatment and cure.

     

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