Clinical features and typing of hepatitis B virus-related acute-on-chronic liver failure based on recommendations of the World Congress of Gastroenterology

Objective To investigate the clinical features and prognosis of patients with different types of hepatitis B virus-related acute-on-chronic liver failure ( HBV-ACLF) . Methods A retrospective analysis was performed for the clinical data of 296 patients with HBV-ACLF who were admitted to 302 Hospital of PLA from January to December, 2016 and diagnosed based on recommendations of the World Congress of Gastroenterology, and according to the pathogenesis, these patients were divided into chronic hepatitis group ( type A group with 53 patients) , compensated cirrhosis group ( type B group with 151 patients) , and decompensated cirrhosis group ( type C group with 92 patients) . Laboratory markers, incidence of comorbidities, and prognosis were analyzed for all groups. An analysis of variance was used for comparison of normally distributed continuous data with homogeneity of variance between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data or continuous data with heterogeneity of variance between groups. The Pearson's chi-square test was used for comparison of categorical data between groups. Results There were significant differences in albumin, alanine aminotransferase, and cholinesterase between the three groups ( all P < 0. 05) , and the type A group had the highest levels, followed by the type B group and the type C group.The type A group had significantly higher levels of aspartate aminotransferase and platelet count than the type B group and the type C group ( all P < 0. 05) . The type A group and the type B group had a significantly higher level of total cholesterol than the type C group ( both P<0. 05) . Compared with the type A group and the type B group, the type C group had significantly higher incidence rates of ascites/pleural effusion ( 90. 22% vs 69. 81%/88. 08%, χ2= 12. 964, P < 0. 05) and hepatorenal syndrome ( 43. 48% vs 18. 87%/28. 48%, χ2= 10. 691, P < 0. 05) . The type B group and type C group had a significantly higher incidence rate of peritonitis than the type A group ( 40. 40%/48. 91% vs 22. 64%, χ2= 9. 718, P < 0. 05) . There was a significant difference in improvement rate between the three groups ( 52. 83% vs 45. 70% vs 32. 61%, χ2= 6. 593, P < 0. 05) . Conclusion There are significant differences in biochemical parameters, comorbidities, and prognosis between HBV-ACLF patients with HBV-related chronic hepatitis, compensated cirrhosis, and decompensated cirrhosis.Such a typing method helps to explore treatment measures and assess prognosis.