Clinical characteristics and prognosis of acute on chronic liver failure in patients with recompensatory hepatitis B cirrhosis

Lei LIU; Jing LIANG; Baiguo XU; Fei WANG; Jia LIAN; Yankai YANG

doi:10.3969/j.issn.1001-5256.2023.01.011

Volume 39 Issue 1

Jan. 2023

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Article Navigation > Journal of Clinical Hepatology > 2023 > 39(1): 70-76

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Clinical characteristics and prognosis of acute on chronic liver failure in patients with recompensatory hepatitis B cirrhosis

DOI: 10.3969/j.issn.1001-5256.2023.01.011

Lei LIU^{1, 2},
Jing LIANG^{1, 2
,
,
,},
Baiguo XU^{1, 2},
Fei WANG^{1, 2},
Jia LIAN^{1, 2},
Yankai YANG²

1.
The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China
2.
Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital; Tianjin Key Laboratory of Artificial Cells; Tianjin Institute of Hepatobiliary Disease; Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin 300170, China

Research funding:

Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-034A);

Tianjin Health Project (TJWJ2022XK029)

More Information

Corresponding author: LIANG Jing, haolele77@sina.com(ORCID: 0000-0001-5114-9030)
Received Date: 2022-07-07
Accepted Date: 2022-08-26
Published Date: 2023-01-20

Abstract

Abstract

Objective To assess the clinical characteristics of acute-on-chronic liver failure in patients with recompensatory hepatitis B cirrhosis. Methods A total of 180 patients with acute-on-chronic liver failure hospitalized in Tianjin Third Central Hospital from September 2013 to September 2021 were retrospectively collected, with 110 patients had compensatory hepatitis B cirrhosis and 70 patients had compensatory hepatitis B cirrhosis and used as the control. Their causes, clinical biochemical indicators, complication rate, and prognosis were compared. The Chi-square test or Fisher's exact test was used for comparison of categorical variables between groups, and the Mann-Whitney U test was performed for analysis of the continuous variables. Kaplan-Meier curves and Log-rank test were used for survival of patients. Results The incidence of hepatorenal syndrome (χ²=4.618, P=0.032), infection (χ²=6.712, P=0.010), Cr (Z =-4.508, P < 0.001), and PCT (Z=-2.052, P=0.040) were all higher, whereas GGT (Z=-2.042, P=0.041), Na (Z=-2.001, P=0.045), FBS (Z=-3.065, P=0.002), and TC (Z=-4.268, P < 0.001) were all lower in the recompensation group than in the control group of patients. However, 90-day mortality rate (χ²=3.366, P=0.067) and 1-year mortality rate (χ²=1.893, P=0.169), 90-day survival (χ²=2.68, P=0.100), and 1-year survival (χ²=2.074, P=0.150) were not statistically significant difference. Conclusion Compared with compensatory hepatitis B cirrhosis, patients with recompensatory cirrhosis had an increased risk in developing hepatorenal syndrome, infection, and increased creatinine level after acute-on-chronic liver failure, although there was no statistically significant difference in 90-days and 1-year survival of patients.
- Hepatitis B,
- Liver Cirrhosis,
- Acute-On-Chronic Liver Failure,
- Prognosis

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References

[1]	LOK AS. Hepatitis: Long-term therapy of chronic hepatitis B reverses cirrhosis[J]. Nat Rev Gastroenterol Hepatol, 2013, 10(4): 199-200. DOI: 10.1038/nrgastro.2013.13.
[2]	MARCELLIN P, ASSELAH T. Long-term therapy for chronic hepatitis B: hepatitis B virus DNA suppression leading to cirrhosis reversal[J]. J Gastroenterol Hepatol, 2013, 28(6): 912-923. DOI: 10.1111/jgh.12213.
[3]	DIENSTAG JL, GOLDIN RD, HEATHCOTE EJ, et al. Histological outcome during long-term lamivudine therapy[J]. Gastroenterology, 2003, 124(1): 105-117. DOI: 10.1053/gast.2003.50013.
[4]	HADZIYANNIS SJ, TASSOPOULOS NC, HEATHCOTE EJ, et al. Long-term therapy with adefovir dipivoxil for HBeAg-negative chronic hepatitis B for up to 5 years[J]. Gastroenterology, 2006, 131(6): 1743-1751. DOI: 10.1053/j.gastro.2006.09.020.
[5]	KONG Y, SUN Y, ZHOU J, et al. Early steep decline of liver stiffness predicts histological reversal of fibrosis in chronic hepatitis B patients treated with entecavir[J]. J Viral Hepat, 2019, 26(5): 576-585. DOI: 10.1111/jvh.13058.
[6]	BUTI M, FUNG S, GANE E, et al. Long-term clinical outcomes in cirrhotic chronic hepatitis B patients treated with tenofovir disoproxil fumarate for up to 5 years[J]. Hepatol Int, 2015, 9(2): 243-250. DOI: 10.1007/s12072-015-9614-4.
[7]	SARIN SK, CHOUDHURY A, SHARMA MK, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update[J]. Hepatol Int, 2019, 13(4): 353-390. DOI: 10.1007/s12072-019-09946-3.
[8]	de FRANCHIS R, BOSCH J, GARCIA-TSAO G, et al. Baveno VⅡ - Renewing consensus in portal hypertension[J]. J Hepatol, 2022, 76(4): 959-974. DOI: 10.1016/j.jhep.2021.12.022.
[9]	Chinese Society of Hepatology, Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B (2010 version)[J]. J Clin Hepatol, 2011, 27(1): Ⅰ-ⅩⅥ. https://www.cnki.com.cn/Article/CJFDTOTAL-LCGD201108002.htm 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2010版)[J]. 临床肝胆病杂志, 2011, 27(1): Ⅰ-ⅩⅥ. https://www.cnki.com.cn/Article/CJFDTOTAL-LCGD201108002.htm
[10]	Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B: a 2015 update[J]. J Clin Hepatol, 2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002. 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志, 2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002.
[11]	Group of Liver Failure and Artificial Liver, Chinese Society of Infectious Diseases, Chinese Medical Association; Group of severe Liver disease and Artificial Liver, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for diagnosis and treatment of hepatic failure (2012 edition)[J]. Inter J Epidemiol Infect Dis, 2013, 40(1): 1-7. DOI: 10.3760/cma.j.issn.1673-4149.2013.01.001. 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(2012年版)[J]. 国际流行病学传染病学杂志, 2013, 40(1): 1-7. DOI: 10.3760/cma.j.issn.1673-4149.2013.01.001.
[12]	Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006. 中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
[13]	CAO ZJ, ZHANG CX, XIE Q. Paving the way to improve clinical management of acute-on-chronic liver failure using international criteria[J]. J Clin Hepatol, 2021, 37(4): 745-751. DOI: 10.3969/j.issn.1001-5256.2021.04.001. 曹竹君, 张宸溪, 谢青. 慢加急性肝衰竭的国际标准与临床管理优化[J]. 临床肝胆病杂志, 2021, 37(4): 745-751. DOI: 10.3969/j.issn.1001-5256.2021.04.001.
[14]	MOREAU R, JALAN R, GINES P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis[J]. Gastroenterology, 2013, 144(7): 1426-1437. DOI: 10.1053/j.gastro.2013.02.042.
[15]	SHI Y, YANG Y, HU Y, et al. Acute-on-chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults[J]. Hepatology, 2015, 62(1): 232-242. DOI: 10.1002/hep.27795.
[16]	YIN S, WANG SJ, GU WY, et al. Risk of different precipitating events for progressing to acute-on-chronic liver failure in HBV-related cirrhotic patients[J]. J Dig Dis, 2017, 18(5): 292-301. DOI: 10.1111/1751-2980.12480.
[17]	CLÀRIA J, STAUBER RE, COENRAAD MJ, et al. Systemic inflammation in decompensated cirrhosis: Characterization and role in acute-on-chronic liver failure[J]. Hepatology, 2016, 64(4): 1249-1264. DOI: 10.1002/hep.28740.
[18]	DIRCHWOLF M, PODHORZER A, MARINO M, et al. Immune dysfunction in cirrhosis: Distinct cytokines phenotypes according to cirrhosis severity[J]. Cytokine, 2016, 77: 14-25. DOI: 10.1016/j.cyto.2015.10.006.
[19]	ALBILLOS A, LARIO M, ÁLVAREZ-MON M. Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance[J]. J Hepatol, 2014, 61(6): 1385-1396. DOI: 10.1016/j.jhep.2014.08.010.
[20]	THABUT D, MASSARD J, GANGLOFF A, et al. Model for end-stage liver disease score and systemic inflammatory response are major prognostic factors in patients with cirrhosis and acute functional renal failure[J]. Hepatology, 2007, 46(6): 1872-1882. DOI: 10.1002/hep.21920.
[21]	FERNÁNDEZ J, ACEVEDO J, WIEST R, et al. Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis[J]. Gut, 2018, 67(10): 1870-1880. DOI: 10.1136/gutjnl-2017-314240.
[22]	XU KC. Liver function detection technology and evaluation[M]//WANG BE, ZHANG DF. Modern Hepatology. Beijing: Science Press, 2003: 192. 徐克成. 肝功能检测技术及评价[M]//王宝恩, 张定凤. 现代肝脏病学. 北京: 科学出版社, 2003: 192.
[23]	MEDZHITOV R, SCHNEIDER DS, SOARES MP. Disease tolerance as a defense strategy[J]. Science, 2012, 335(6071): 936-941. DOI: 10.1126/science.1214935.

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Clinical characteristics and prognosis of acute on chronic liver failure in patients with recompensatory hepatitis B cirrhosis

DOI: 10.3969/j.issn.1001-5256.2023.01.011