Inappropriate cessation of nucleos(t)ide analog associated with reduced liver transplant-free survival in patients with HBV-related acute on chronic liver failure

Shi, Hong; Xiao, Gemin; Liao, Mei; Zheng, Liang; Jie, Yusheng; Lin, Guoli; Chong, Yutian

doi:10.1016/j.biopha.2020.111118

Cited by 6 publications

(5 citation statements)

References 22 publications

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“…Of note, withdrawal of NA is an important acute injury event [ 20 ], and its incidence has been increasing in recent years. Consistent with our study, Shi et al [ 21 ] found that HBV-ACLF patients who self-discontinued NA showed a poor short-term prognosis. However, there is no prognostic model for HBV-ACLF patients, including the intrahepatic precipitating factor.…”

Section: Discussionsupporting

confidence: 93%

Long-term prognosis of patients with hepatitis B virus–related acute-on-chronic liver failure: a retrospective study

Wang

et al. 2022

BMC Gastroenterol

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Background The long-term prognosis of patients with hepatitis B virus–related acute-on-chronic liver failure (HBV-ACLF) is not well characterised. We assessed long-term outcomes and the associated risk factors of HBV-ACLF patients in southern China. Methods We retrospectively analysed clinical data, adverse events, and clinical endpoint events of HBV-ACLF patients treated at our department between January 2014 and December 2018. Results A total of 616 (52.3%) patients with cirrhosis and 561 (47.7%) patients without cirrhosis were included. In 973 (83%) patients, the disease was associated only with HBV, while 204 (17%) patients had two or more aetiological factors. The proportion of patients receiving antiviral treatment for HBV was low (20.3%). Further analyses indicated that patients without cirrhosis had a significantly lower 90-day liver transplantation–free mortality and higher 5‐year survival rate than those with cirrhosis (59.5% vs. 27.6%; 62% vs. 36%; P < 0.05). Remarkably, self-withdrawal of nucleos(t)ide analog (NA) was an independent risk factor for short-term prognosis. Age, cirrhosis at admission, and platelet level were closely related to long-term prognosis of HBV-ACLF patients. Conclusion The proportion of HBV-ACLF patients receiving antiviral treatment is very low in south China. Cirrhosis at admission has a significant effect on both short-term and long-term prognosis. No significant improvement in the short-term prognosis of HBV-ACLF patients was observed compared with previous studies. More comprehensive access to antiviral treatment and long-term surveillance of HBV patients are key imperatives to reduce the incidence of HBV-ACLF and improve the prognosis. Trial Registration The trial was registered at ClinicalTrials.gov (CT.gov identifier: NCT04231565) on May 13, 2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009OZY&selectaction=Edit&uid=U00036P1&ts=2&cx=27seqt

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Section: Discussionsupporting

confidence: 93%

Long-term prognosis of patients with hepatitis B virus–related acute-on-chronic liver failure: a retrospective study

Wang

et al. 2022

BMC Gastroenterol

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“…Compared with other acute intrahepatic etiologies, patients who discontinued NAs were shown to have a worse short-term prognosis [26] . In a study by Shi et al [27] , withdrawal of NAs was a strong independent risk factor for 90-day mortality in HBV-ACLF patients, which was consistent with our study. However, there is no prognostic model for HBV-ACLF patients that includes the intrahepatic precipitating factor.…”

Section: Discussionsupporting

confidence: 93%

Long-Term Prognosis of Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure: A Retrospective Study

Wang

et al. 2021

Preprint

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Introduction and Objectives: The long-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is not well characterized. We sought to assess the short-term and long-term outcomes and the associated risk factors of HBV-ACLF patients in south China.Patients and Methods: We retrospectively analyzed clinical data, adverse events, and clinical endpoint events of HBV-ACLF patients treated at our department between January 2014 and December 2018. Results: A total of 1177 HBV-ACLF patients were included in the study, including 616 (52.3%) cirrhotic patients and 561 (47.7%) non-cirrhotic patients. 973 (83%) patients were associated only with HBV, and 204 (17%) patients had two or more etiologies. The leading cause of simple HBV-ACLF patients was lack of antiviral treatment and the proportion of patients receiving antiviral treatment for HBV was low (20%). Further analyses indicated non-cirrhotic patients had a significantly lower 90-day transplantation‐free mortality and greater 5‐year survival rate than cirrhotic patients (59.5% vs. 27.6%, 62% vs. 36%, P＜0.05). Age, hepatic encephalopathy, liver cirrhosis, nucleoside (acid) analogues (NAs) withdrawal, total bilirubin, and prothrombin time were independent risk factors for 90-day mortality in HBV-ACLF patients. Cirrhosis at admission (AOR=3.675, 95% CI: 2.408–6.594) was a strong independent risk factor for long-term prognosis. Conclusion: The proportion of HBV-ACLF patients receiving antiviral treatment was extremely low in south China. HBV combined with acute hepatitis E, or DILI had no significant effect on the short-term mortality rate in HBV-ACLF patients. Remarkably, the effect of withdrawal of NAs and cirrhosis on short-term outcomes cannot be ignored. No significant improvement in the short-term prognosis of HBV-ACLF patients was observed compared with previous studies. Trial Registration: The trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT04231565). Registered 13 May 2020https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009OZY&selectaction=Edit&uid=U00036P1&ts=2&cx=27seqt

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“…Previous study also investigated several important indicators of poor prognosis in ACLF patients [24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

The Short-Term Efficacy of Tenofovir Alafenamide (TAF) in Acute-On-Chronic Liver Failure: A Single Center Experience

Liu

Dong

et al. 2021

Preprint

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Background and aims: Entecavir (ETV) and tenofovir disoproxil fumarate (TDF) reduce hepatic events and death in patients with acute-on-chronic liver failure (ACLF), but the efficacy of Tenofovir alafenamide (TAF) is less well studied. We aimed to assess the effectiveness of TAF in hepatitis B virus (HBV) related ACLF.Methods: We analyzed 106 patients with HBV-ACLF received TAF (25mg/d), ETV(0.5mg/d) for 12 weeks. The primary endpoints were overall mortality and liver transplantation (LT) at week 12. Other determined factors of biochemical response, virologic response, mortality rate, and drug safety and side-effect were also evaluated.Results: At 4 weeks and 12 weeks, patients received TAF got significantly higher HBV-DNA reduction (P<0.001), higher rate of HBV-DNA undetectbility (P<0.001), lower HBV-DNA level (P<0.001). Lower CTP scores (P=0.003) at 4 weeks in TAF group, but CTP scores showed no difference in two groups at 12 weeks (P=1.143). Lower ALT levels in TAF group at week 4 and week 12 (P=0.023, P<0.0001). The mortality rate was lower in TAF group after 4 weeks treatment(P=0.038), but two group got similar mortality rate at week 8 and week 12. As for reason cause death in HBV-ACLF patients, we found that two group patients developed similar rates of liver-related complications (P>0.05).Conclusions: The antiviral efficacy of TAF was superior than ETV for the treatment of HBV-related ACLF. TAF therapy reduced 4-week mortality rate in patients with HBV-related ACLF.

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Inappropriate cessation of nucleos(t)ide analog associated with reduced liver transplant-free survival in patients with HBV-related acute on chronic liver failure

Cited by 6 publications

References 22 publications

Long-term prognosis of patients with hepatitis B virus–related acute-on-chronic liver failure: a retrospective study

Long-term prognosis of patients with hepatitis B virus–related acute-on-chronic liver failure: a retrospective study

Long-Term Prognosis of Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure: A Retrospective Study

The Short-Term Efficacy of Tenofovir Alafenamide (TAF) in Acute-On-Chronic Liver Failure: A Single Center Experience

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