Clinical features of acute-on-chronic liver failure induced by withdrawal of nucleos (t) ide analogues

Objective To investigate the clinical features of patients with hepatitis B virus-related acute-on-chronic liver failure (ACLF) induced by the withdrawal of nucleos (t) ide analogues (NAs) .Methods A retrospective analysis was performed for the clinical data of 865 patients who were admitted to The First Affiliated Hospital of Nanchang University from June 2014 to October 2016 and diagnosed with ACLF.Among these patients, 137 experienced ACLF induced by drug withdrawal (withdrawal group) and 728 experienced ACLF not induced by drug withdrawal (non-withdrawal group) .The type of antiviral drugs, duration of standard antiviral therapy, withdrawal way, time from withdrawal to the development of liver failure, monitoring after withdrawal, underlying liver diseases, and 30-day mortality after progression to ACLF were recorded in detail.The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Results Of all the 728 patients in the non-withdrawal group, 389 were cured or improved and 339 died or had no response.Of all the 137 patients in the withdrawal group, 69 had chronic viral hepatitis, among whom 40 were cured or improved and 29 died or had no response;68 had liver cirrhosis, among whom 16 were cured or improved and 52 died or had no response;there was a significant difference (χ2=16.81, P<0.001) 6="" 16="" 25="" 32="" 33="" 37="" 47="" 79="" 137="" .of="" all="" the="" patients="" in="" withdrawal="" before="" used="" adefovir="" lamivudine="" combined="" with="" and="" entecavir.of="" when="" they="" developed="" had="" a="" duration="" of="" drug="" 6-12="">12 months.Conclusion Improper withdrawal of NAs can easily induce ACLF.The changes in virologic parameters, liver function parameters, and liver imaging findings should be closely monitored for patients with hepatitis B within 6 months after withdrawal.Underlying liver diseases determine the development and prognosis of ACLF after withdrawal, and long-term standard antiviral therapy is of great importance in patients with liver cirrhosis.