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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 4
Apr.  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(4): 788-792

Clinical features and prognosis of HBV-related acute-on-chronic liver failure in pregnancy

DOI: 10.3969/j.issn.1001-5256.2022.04.010

  • Shanghai Public Health Clinical Center Affiliated to Fudan University, Shanghai 201508, China

Research funding:

The Shanghai Municipal Education Commission Gaofeng Clinical Medicine Grant Support and Shanghai Hospital Development Center Funding (SHDC2020CR1037B-004);

National Science and Technology Major Project during the 13th Five-Year Plan Period (2018ZX10725506-002);

Project of Shanghai Municipal Health Commission (20184Y0058)

More Information
  • Corresponding author: WANG Jiefei, wangjiefei@shaphc.org(ORCID: 0000-0002-6283-5965); QIAN Zhiping, qianzhiping@shaphc.org(ORCID: 0000-0003-4641-3348)
  • Received Date: 2021-09-13
  • Accepted Date: 2021-10-18
  • Published Date: 2022-04-20
    Abstract
  •   Objective  To investigate the clinical features and prognosis of pregnant women with HBV-related acute-on-chronic liver failure (HBV-ACLF).  Methods  A retrospective analysis was performed for the clinical data of 26 pregnant women with HBV-ACLF who were admitted to Shanghai Public Health Clinical Center from June 2008 to July 2020, including age, gestational weeks at disease onset, parity, initial symptoms, complications on admission, laboratory markers [white blood cell count, hemoglobin, platelet count, alanine aminotransferase, total bilirubin (TBil), albumin, serum creatinine, Model for End-Stage Liver Disease (MELD) score, HBsAg, and HBV DNA], abdominal ultrasound, mode of delivery, fetus conditions, treatment measures, and prognosis. The t-test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test and the Fisher's exact test were used for comparison of categorical data between two groups.  Results  Among the 26 patients, 8 died within 28 days after disease onset, and the mortality rate reached 30.8%. There were 22 multiparous patients, accounting for 84.6%, and HBV-ACLF often occurred in the third trimester of pregnancy (20/26, 76.9%), with a mean gestational age of 30.9±5.8 weeks. HBV-ACLF often had atypical clinical manifestations, and initial symptoms included weakness, poor appetite (21/26, 80.8%), and yellow urine (19/26, 73.1%). Compared with the survival group, the death group had significantly higher levels of TBil (Z=-2.056, P=0.041), prothrombin time (Z=-2.362, P=0.016), international normalized ratio (Z=-2.528, P=0.009), and MELD score (Z=-2.223, P=0.026), a significantly longer time from initial symptom to diagnosis (Z=-2.468, P=0.021), significantly higher HBV DNA level (χ2=7.571, P=0.021), degree of hepatic encephalopathy (χ2=24.775, P < 0.001), and incidence rate of complications (χ2=5.951, P=0.042), and significantly lower levels of fibrinogen (Z=-2.667, P=0.006) and prothrombin time activity (Z=-2.365, P=0.016).  Conclusion  HBV-ACLF is a serious complication in the third trimester of pregnancy and is often observed in multiparous patients, with an extremely high short-term mortality. It often has atypical clinical manifestations in the early stage, and high MELD score, high viral load, and complications often indicate a poor prognosis.

     

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    • References(20)
  • [1]
    TRAN TT, AHN J, REAU NS. ACG clinical guideline: Liver disease and pregnancy[J]. Am J Gastroenterol, 2016, 111(2): 176-194; quiz 196. DOI: 10.1038/ajg.2015.430.
    [2]
    LOBSTEIN S, FABER R, TILLMANN HL. Prevalence of hepatitis B among pregnant women and its impact on pregnancy and newborn complications at a tertiary hospital in the eastern part of Germany[J]. Digestion, 2011, 83(1-2): 76-82. DOI: 10.1159/000320455.
    [3]
    WANG ZL, GAO S, LI L, et al. Demethylation of tumor necrosis factor-α converting enzyme predicts poor prognosis in acute-on-chronic hepatitis B liver failure[J]. Clin Res Hepatol Gastroenterol, 2016, 40(4): 457-464. DOI: 10.1016/j.clinre.2015.12.004.
    [4]
    KATOONIZADEH A, LALEMAN W, VERSLYPE C, et al. Early features of acute-on-chronic alcoholic liver failure: A prospective cohort study[J]. Gut, 2010, 59(11): 1561-1569. DOI: 10.1136/gut.2009.189639.
    [5]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical 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.
    [6]
    ANGELI P, GINÈS P, WONG F, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: Revised consensus recommendations of the International Club of Ascites[J]. J Hepatol, 2015, 62(4): 968-974. DOI: 10.1016/j.jhep.2014.12.029.
    [7]
    Obstetrics Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association. Guidelines for prevention and treatment of postpartum hemorrhage[J]. Chin J Obstet Gynecol, 2014, 49(9): 641-646. DOI: 10.3760/cma.j.issn.0529-567x.2016.06.001.

    中华医学会妇产科学分会产科学组. 产后出血预防与处理指南[J]. 中华妇产科杂志, 2014, 49(9): 641-646. DOI: 10.3760/cma.j.issn.0529-567x.2016.06.001.
    [8]
    KAMATH PS, WIESNER RH, MALINCHOC M, et al. A model to predict survival in patients with end-stage liver disease[J]. Hepatology, 2001, 33(2): 464-470. DOI: 10.1053/jhep.2001.22172.
    [9]
    LYU SC, ZHANG BZ. Etiology, clinical manifestations, and prognosis of liver failure in pregnancy[J]. J Clin Hepatol, 2020, 36(12): 2756-2760. DOI: 10.3969/j.issn.1001-5256.2020.12.023.

    吕苏聪, 张宝忠. 妊娠期肝衰竭的病因、临床表现及预后分析[J]. 临床肝胆病杂志, 2020, 36(12): 2756-2760. DOI: 10.3969/j.issn.1001-5256.2020.12.023.
    [10]
    CORDOBA J, VENTURA-COTS M, SIMÓN-TALERO M, et al. Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF)[J]. J Hepatol, 2014, 60(2): 275-281. DOI: 10.1016/j.jhep.2013.10.004.
    [11]
    BANAIT VS, SANDUR V, PARIKH F, et al. Outcome of acute liver failure due to acute hepatitis E in pregnant women[J]. Indian J Gastroenterol, 2007, 26(1): 6-10.
    [12]
    SAHAI S, KIRAN R. Acute liver failure in pregnancy: Causative and prognostic factors[J]. Saudi J Gastroenterol, 2015, 21(1): 30-34. DOI: 10.4103/1319-3767.151221.
    [13]
    SHAO Z, ZHAO Y, FENG L, et al. Association between plasma fibrinogen levels and mortality in acute-on-chronic hepatitis B liver failure[J]. Dis Markers, 2015, 2015: 468596. DOI: 10.1155/2015/468596.
    [14]
    CUI YP, LIU FH, SHI QF, et al. Logistic regression analysis of prognostic factors in 106 acute-on-chronic liver failure patients with hepatic encephalopathy[J]. J Clin Hepatol, 2014, 30(10): 992-995. DOI: 10.3969/j.issn.1001-5256.2014.10.005.

    崔燕平, 刘凤华, 石庆凤, 等. 106例慢加急性肝衰竭合并肝性脑病患者预后影响因素的Logistic回归分析[J]. 临床肝胆病杂志, 2014, 30(10): 992-995. DOI: 10.3969/j.issn.1001-5256.2014.10.005.
    [15]
    ROUILLARD SS, BASS NM, ROBERTS JP, et al. Severe hyperbilirubinemia after creation of transjugular intrahepatic portosystemic shunts: Natural history and predictors of outcome[J]. Ann Intern Med, 1998, 128(5): 374-377. DOI: 10.7326/0003-4819-128-5-199803010-00006.
    [16]
    SOLANKE D, RATHI C, PANDEY V, et al. Etiology, clinical profile, and outcome of liver disease in pregnancy with predictors of maternal mortality: A prospective study from Western India[J]. Indian J Gastroenterol, 2016, 35(6): 450-458. DOI: 10.1007/s12664-016-0704-6.
    [17]
    GARG H, SARIN SK, KUMAR M, et al. Tenofovir improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure[J]. Hepatology, 2011, 53(3): 774-780. DOI: 10.1002/hep.24109.
    [18]
    LIU CR, LI YP, LUO S, et al. Influencing factors for the short-term prognosis of patients with HBV-related acute-on-chronic liver failure[J]. J Clin Hepatol, 2021, 37(1): 56-62. DOI: 10.3969/j.issn.1001-5256.2021.01.012.

    刘晨瑞, 李亚萍, 罗森, 等. HBV相关慢加急性肝衰竭患者短期预后的影响因素分析[J]. 临床肝胆病杂志, 2021, 37(1): 56-62. DOI: 10.3969/j.issn.1001-5256.2021.01.012.
    [19]
    HSU C, HSIUNG CA, SU IJ, et al. A revisit of prophylactic lamivudine for chemotherapy-associated hepatitis B reactivation in non-Hodgkin's lymphoma: A randomized trial[J]. Hepatology, 2008, 47(3): 844-853. DOI: 10.1002/hep.22106.
    [20]
    Chinese Society of Infectious Diseases, Chinese Medical Association, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for the prevention and treatment of chronic hepatitis B (version 2019)[J]. J Clin Hepatol, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.

    中华医学会感染病学分会, 中华医学会肝病学分会. 慢性乙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2648-2669. DOI: 10.3969/j.issn.1001-5256.2019.12.007.
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