Prognostic factors of the short-term outcomes of patients with hepatitis B virus-associated acute-on-chronic liver failure

Lei, Qing; Ao, Kang-Jian; Zhang, Yinhua; Ma, Dawei; Ding, Deping; Chen, Ke; Chen, Yue; Luo, Jie; Meng, Zhe

doi:10.6061/clinics/2017(11)07

Cited by 8 publications

(6 citation statements)

References 23 publications

(22 reference statements)

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“…It is consistent with the level of protein metabolism and has been extensively reported in kidney disease, diabetes, pregnancyinduced hypertension, and fever following Transcatheter Arterial Embolization (TAE) (10)(11)(12)(13). In a previous prospective study, Lei et al suggested that serum urea could predict short-term outcomes of patients with hepatitis B virusassociated Acute-on-chronic Liver Failure (ACLF) (14). Mjasnikova et al suggested that serum urea was associated with the Model for End-stage Liver Disease (MELD) score in HCV-induced liver cirrhosis, as well as with esophageal vein bleeding (15).…”

Section: Introductionsupporting

confidence: 76%

“…The results of Lei et al's study indicated that serum urea was significantly associated with the short-term outcomes of hepatitis B virus-associated acute-on-chronic liver failure (14). Hence, we assume that the level of urea is a comprehensive marker of gastrointestinal hemorrhage, protein metabolism, and kidney function, which strongly impacts the prognosis of DeCi patients.…”

Section: Discussionmentioning

confidence: 92%

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Serum Urea Predicts Long-term Mortality in Hospitalized Patients with Decompensated Cirrhosis

et al. 2020

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Objectives:The purpose of the present study was to investigate the prognostic value of serum urea for 90 days and six months' mortality in hospitalized patients with Decompensated Cirrhosis (DeCi). Methods: We performed a single-center, observational prospective study with data from 456 enrolled patients with DeCi. The biochemical examination and patient demographics were obtained upon admission after 24 h. All patients were observed until death, loss to follow-up, or for six months. Univariate and multivariate analyses were used to determine whether serum urea was independently associated with the prognosis of DeCi patients. The AUROC was implemented to test the predictive accuracy compared to existing scores. Results: Serum urea was significantly higher in non-surviving patients than in surviving patients. Multivariate analysis demonstrated that the urea level was an independent predictor of 90 days' (odds ratio: 1.084, P = 0.001) and six months' (odds ratio: 1.070, P = 0.009) mortality. The ROC curves were established to evaluate the relative efficiencies of the urea level for predicting 90 days' (AUROC: 0.728, P < 0.0001) and six months' (AUROC: 0.715, P < 0.0001) mortality. The performance of the new scores, in which lg urea was added to the MELD score and the Child-Pugh score, was better than the MELD score and Child-Pugh score alone, respectively (P < 0.001). Conclusions: Serum urea levels at admission may be useful for predicting long-term mortality in DeCi patients and the predictive value of MELD score and Child-Pugh score improved by adding lg urea.

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Section: Introductionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 92%

Serum Urea Predicts Long-term Mortality in Hospitalized Patients with Decompensated Cirrhosis

et al. 2020

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“…Various score models have been proposed to predict the prognosis of liver failure[14,33]. In this study, MELD, MELD-Na, iMELD, CTP, and ALBI scores were all markedly higher in HBV-ACLF patients with infections than in their counterparts without infections.…”

Section: Discussionmentioning

confidence: 61%

“…Model for End-Stage Liver Disease (MELD) score, MELD-sodium (MELD-Na) score, integrated MELD (iMELD) score, Child-Turcotte-Pugh (CTP) score, albumin-bilirubin (ALBI) score, and the ACLF grading system were used as described in the previous literature[2,14]. CTP score is the cumulative result of the scores for five items (ascites, hepatic encephalopathy, TBIL, Alb, and PT extension time), with 1-3 points for each item and a maximum of 15 points.…”

Section: Methodsmentioning

confidence: 99%

Incidence of infectious complications is associated with a high mortality in patients with hepatitis B virus-related acute-on-chronic liver failure

Wang¹,

Ma²,

Luo³

et al. 2019

WJCC

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BACKGROUNDIn China, hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is the most common liver failure characterized by serious clinical syndromes of liver decompensation with a very high mortality. Bacterial and/or fungal infections are the most common complications that are associated with high short-term mortality. Bacterial translocation from the intestine, impaired hepatic clearance, and immune paralysis of circulating immune cells are thought to contribute to infectious complications in liver failure. The control of bacterial and fungal infections is the key to improving HBV-ACLF outcomes. Active prevention, early diagnosis, and timely treatment of bacterial and fungal infections are essential for treating HBV-ACLF.AIMTo investigate the frequency and role of bacterial and fungal infections in patients with HBV-ACLF.METHODSPatients with HBV-ACLF hospitalized at Taihe Hospital, Hubei University of Medicine from January 2014 to December 2017 were retrospectively enrolled. Patient-related information was retrieved from the hospital case database, including general information, blood biochemistry, complications, etc. According to the occurrence of secondary infection or not, the patients were divided into an infection group and a non-infection group. The sites, types, and incidences of bacterial and fungal infections and the influence of infections on the prognosis of HBV-ACLF were statistically analyzed. The risk factors for infections were assessed by unconditional logistic regression.RESULTSThere were 174 cases of HBV-ACLF that met the enrollment criteria, of which 114 (65.52%) were diagnosed with infectious complications. Infections occurred in the abdominal cavity (87 cases), respiratory tract (51 cases), urinary tract (18 cases), and biliary tract (10 cases). Patients with infectious complications had a significantly higher 28-d mortality (70.18%, 80/114) than those without (40.00%, 24/60) (70.18% vs 40.00%, P < 0.05). And patients with infectious complications had a much higher incidence of non-infectious complications (54.39%, 62/114) (54.39% vs 15.00%, P < 0.05), leading to an extremely high 28-d mortality of 88.71% (55/62) (P < 0.05). The grade of liver failure, period of hospital stay ≥ 30 d, age ≥ 45 years, and percentage of neutrophils > 70% were identified as risk factors for infectious complications.CONCLUSIONThe high incidence of infectious complications in patients with HBV-ACLF is associated with severity and deterioration of the disease and may contribute to the extremely high mortality of these patients.

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“…For example, Gao et al combined neutrophil to lymphocyte ratio (NLR), HE, INR, age and TBIL to construct a prediction model for 90-day mortality of HBV-ACLF, which showed better predictive values in comparison with MELD, MELD-Na, and CTP [25]. Lei et al proposed a formula model based on NLR, GGT, albumin, sodium and artificial liver support therapy to predict short-term mortality of HBV-ACLF [26]. Chen et al combined age, serum sodium and MELD score to develop a prognostic nomogram to assess 3-month mortality of HBV-ACLF, which exhibited better efficacy than MELD, MELD-Na and iMELD [27].…”

Section: Discussionmentioning

confidence: 99%

Artificial neural network-based models used for predicting 28- and 90-day mortality of patients with hepatitis B-associated acute-on-chronic liver failure

et al. 2020

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Background: This study aimed to develop prognostic models for predicting 28-and 90-day mortality rates of hepatitis B virus (HBV)-associated acute-on-chronic liver failure (HBV-ACLF) through artificial neural network (ANN) systems. Methods: Six hundred and eight-four cases of consecutive HBV-ACLF patients were retrospectively reviewed. Four hundred and twenty-three cases were used for training and constructing ANN models, and the remaining 261 cases were for validating the established models. Predictors associated with mortality were determined by univariate analysis and were then included in ANN models for predicting prognosis of mortality. The receiver operating characteristic curve analysis was used to evaluate the predictive performance of the ANN models in comparison with various current prognostic models. Results: Variables with statistically significant difference or important clinical characteristics were input in the ANN training process, and eight independent risk factors, including age, hepatic encephalopathy, serum sodium, prothrombin activity, γ-glutamyltransferase, hepatitis B e antigen, alkaline phosphatase and total bilirubin, were eventually used to establish ANN models. For 28-day mortality in the training cohort, the model's predictive accuracy (AUR 0.948, 95% CI 0.925-0.970) was significantly higher than that of the Model for End-stage Liver Disease (MELD), MELD-sodium (MELD-Na), Chronic Liver Failure-ACLF (CLIF-ACLF), and Child-Turcotte-Pugh (CTP) (all p < 0.001). In the validation cohorts the predictive accuracy of ANN model (AUR 0.748, 95% CI: 0.673-0.822) was significantly higher than that of MELD (p = 0.0099) and insignificantly higher than that of MELD-Na, CTP and CLIF-ACLF (p > 0.05). For 90-day mortality in the training cohort, the model's predictive accuracy (AUR 0.913, 95% CI 0.887-0.938) was significantly higher than that of MELD, MELD-Na, CTP and CLIF-ACLF (all p < 0.001). In the validation cohorts, the prediction accuracy of the ANN model (AUR 0.754, 95% CI: 0.697-0.812 was significantly higher than that of MELD (p = 0.019) and insignificantly higher than MELD-Na, CTP and CLIF-ACLF (p > 0.05).

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Prognostic factors of the short-term outcomes of patients with hepatitis B virus-associated acute-on-chronic liver failure

Cited by 8 publications

References 23 publications

Serum Urea Predicts Long-term Mortality in Hospitalized Patients with Decompensated Cirrhosis

Serum Urea Predicts Long-term Mortality in Hospitalized Patients with Decompensated Cirrhosis

Incidence of infectious complications is associated with a high mortality in patients with hepatitis B virus-related acute-on-chronic liver failure

Artificial neural network-based models used for predicting 28- and 90-day mortality of patients with hepatitis B-associated acute-on-chronic liver failure

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