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CN 22-1108/R
Volume 41 Issue 9
Sep.  2025
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Article Navigation >  Journal of Clinical Hepatology  > 2025  >  41(9): 1771-1778

Dynamic changes of prognostic scores and related clinical indicators in hepatitis B virus-related acute-on-chronic liver failure patients without underlying liver cirrhosis and their relationship with clinical outcomes

DOI: 10.12449/JCH250911
  • 1.

    Fourth Department of Liver Disease Center，Beijing YouAn Hospital，Capital Medical University，Beijing 100069，China

  • 2.

    Beijing Key Laboratory of Liver Regeneration and Artificial Liver Transformation Research，Beijing 100069，China

Research funding:

Capital’s Funds for Health Improvement and Research (CFH2024-1-2181);

Construction Project of High-level Technology Talents in Public Health (Discipline leader-01-12);

Beijing Hospitals Authority’s Ascent Plan (DFL20221501);

National Key Research and Development Program of China (2022YFC2304402)

More Information
  • Corresponding author: CHEN Yu， chybeyond1071@ccmu.edu.cn （ORCID： 0000-0003-1906-7486）
  • Received Date: 2025-03-10
  • Accepted Date: 2025-05-15
  • Published Date: 2025-09-25
    Abstract
  •   Objective  To investigate the dynamic trajectories of prognostic scores and key clinical indicators in hepatitis B virus-related acute-on-chronic liver failure （HBV-ACLF） patients without liver cirrhosis， to clarify their association with outcomes， and to provide new evidence for individualized prognostic assessment.  Methods  A prospective study was conducted for the data of 154 non-cirrhotic HBV-ACLF patients who attended Beijing YouAn Hospital of Capital Medical University from January 2016 to December 2023， including prognostic scores and key biochemical indicators on Days 3， 7， 14， 21， and 28 of the disease course. According to the outcome of patients at 1 year， they were divided into death/liver transplantation group with 43 patients， liver cirrhosis group with 23 patients， and non-liver cirrhosis group with 88 patients， and the trajectory heterogeneity of different outcome subgroups was analyzed. A one-way analysis of variance was used for comparison of normally distributed continuous data among the three groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data among the three groups； the Wilcoxon test was used between two groups. the chi-square test was used for comparison of categorical data between groups. The mean and its 95% confidence interval （CI） were calculated for each indicator at difference time points； the linear interpolation method was used to connect the means at adjacent time points and construct the group-specific longitudinal trend curve； the 95%CI was visualized using the semi-transparent ribbon area， with the transparency parameter （α=0.2） optimized to enhance the visual discrimination of overlapping intervals across multiple groups. A linear mixed-effects model was used to compare the longitudinal changing trend of each indicator between the patients with different outcomes； likelihood ratio was used to evaluate the significance of the interaction effect between time and group， and in case of the significant interaction effect， the slope based on the estimated marginal mean was used for comparison between two groups.  Results  There were significant differences between the three groups in the incidence rates of ascites and grade Ⅲ — Ⅳ hepatic encephalopathy， MELD score， MELD-Na score， CLIF-C ACLF score， COSSH-ACLF Ⅱ score， total bilirubin （TBil）， international normalized ratio （INR）， alpha-fetoprotein， blood sodium， alanine aminotransferase， and procalcitonin at the baseline（all P<0.05）. The analysis of dynamic trajectories showed that the death/liver transplantation group had high levels of prognostic scores and the biochemical parameters of TBil and INR （TBil>400 μmol/L， INR>2.5）， as well as a low level of platelet count （PLT） （<100×10⁹/L）. The non-liver cirrhosis group had rapid improvements in indicators， with TBil<200 μmol/L， INR<1.5， and PLT>100×10⁹/L by day 28， while the liver cirrhosis group showed a trend of recovery， with TBil>200 μmol/L， INR>2.0， and PLT <100×10⁹/L on day 28， with significant global heterogeneity in the temporal trends of the above indicators across the three groups （all P<0.01）.  Conclusion  Dynamic monitoring of prognostic scores and key clinical indicators can effectively stratify the 1-year outcomes of non-cirrhotic patients with HBV-ACLF. Patients with poor prognosis were typically characterized by INR >2.5 and TBil >400 μmol/L. Among those who survived beyond 1 year， individuals who subsequently progressed to cirrhosis were frequently identified by the presence of INR >1.5， TBil >200 μmol/L， and PLT <100×10⁹/L at day 28.

     

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