Characteristics of systemic inflammation in hepatitis B‐precipitated <scp>ACLF</scp>: Differentiate it from No‐<scp>ACLF</scp>

Wu, Wei; Yan, Huadong; Zhao, Hong; Sun, Wenjie; Yang, Qiao; Sheng, Jifang; Shi, Yu

doi:10.1111/liv.13504

Cited by 69 publications

(70 citation statements)

References 26 publications

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“…Generally, HB‐ACLF is believed to be caused by DAMP‐induced sterile inflammation . However, it may be confounded by non‐sterile inflammation, as evidenced by increased circulating microbial burden and up‐regulation of antibacterial genes in leukocytes of HB‐ACLF patients . The positive correlation between Burkholderiaceae and CXC chemokine IP‐10, which is a key chemokine‐driving SI in decompensated cirrhosis and ACLF, suggested that specific bacteria in the circulating microbiome may contribute to SI in HB‐ACLF.…”

Section: Discussionmentioning

confidence: 99%

“…Systemic inflammation (SI) is a key factor driving the occurrence and progression of ACLF, irrespective of aetiology . It can be either sterile or non‐sterile in nature.…”

Section: Introductionmentioning

confidence: 99%

“…In the later stage, HB‐ACLF patients are at high risk of bacterial infections . Furthermore, an up‐regulation of antibacterial genes in circulating leukocytes along with the presence of SI was demonstrated in patients without overt infections . This implies that the equilibrium between bacteria and host was impaired in HB‐ACLF patients, which may represent an increased microbial burden, altered microbial composition and aberrant bacteria‐host interaction.…”

Section: Introductionmentioning

confidence: 99%

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Characterization of the circulating microbiome in acute‐on‐chronic liver failure associated with hepatitis B

Zhang

Zhao

Shi

et al. 2019

Liver International

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are contributed equally. Abbreviations: C-LC, compensated liver cirrhosis; COSSH, the Chinese Group on the Study of Severe Hepatitis B; HB-ACLF, hepatitis B-related acute-on-chronic liver failure; LDA, linear discriminant analysis; LEfSe, Linear discriminant analysis effect size; OUT, operational taxonomic unit; PCoA, principal coordinate analysis; SI, systemic inflammation.Abstract Background: Patients with hepatitis B-related acute-on-chronic liver failure (HB-ACLF) may have an increased circulating microbial burden. This study aimed to assess circulating microbial load and composition and to explore the association between the circulating microbiome and both systemic inflammation (SI) and clinical outcome in HB-ACLF. Methods: Plasma from 50 HB-ACLF patients, 23 healthy controls and 25 patients with compensated liver cirrhosis (C-LC) was analysed for chemokines/cytokines and bacterial DNA and further analysed by 16S rDNApyrosequencing. Linear discriminant analysis effect size (LEfSe) and inferred metagenomics analyses were performed. Results: The circulating bacterial DNA was significantly increased in HB-ACLF patients compared to that in the control groups. The overall microbial diversity was significantly decreased in HB-ACLF patients. HB-ACLF patients were enriched with Moraxellaceae, Sulfurovum, Comamonas and Burkholderiaceae but were depleted in Actinobacteria, Deinococcus-Thermus, Alphaproteobacteria, Xanthomonadaceae and Enterobacteriaceae compared to controls. Network analysis revealed a direct positive correlation between Burkholderiaceae and chemokine IP-10 in HB-ACLF patients. The relative abundance of Prevotellaceae independently predicted 28-day mortality. Inferred functional metagenomics predicted an enrichment of bacteria with genes related to methane, alanine, aspartate, glutamate, pyrimidine, purine and energy metabolism. Conclusions: HB-ACLF patients display increased circulating microbial burden, altered microbiome composition and a shift in microbiome functionality. The alteration in circulating microbiota is associated with SI and clinical outcome in HB-ACLF.

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Section: Discussionmentioning

confidence: 99%

“…Systemic inflammation (SI) is a key factor driving the occurrence and progression of ACLF, irrespective of aetiology . It can be either sterile or non‐sterile in nature.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characterization of the circulating microbiome in acute‐on‐chronic liver failure associated with hepatitis B

Zhang

Zhao

Shi

et al. 2019

Liver International

Self Cite

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“…HBV can cause ACLF in acute infection or in the setting of HBV reactivation in the setting of treatment cessation, HBV resistance, chemotherapy, or immunosuppression . Excess innate immune responses to viral antigens mediated by pathogen‐associated molecular patterns and damage‐associated molecular patterns (DAMPs) may play a role in the development of ACLF . Host and virus genetic factors have also been shown to predispose certain individuals to ACLF due to HBV .…”

Section: Viral Hepatitismentioning

confidence: 99%

Precipitants of Acute‐on‐Chronic Liver Failure: An Opportunity for Preventative Measures to Improve Outcomes

et al. 2020

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Acute-on-chronic liver failure (ACLF) is a feared complication that can develop at any stage of chronic liver disease. The incidence of ACLF is increasing, leading to a significant burden to both the affected individual and health care systems. To date, our understanding of ACLF suggests that it may be initiated by precipitants such as systemic infection, alcohol use, or viral hepatitis. The prevalence of these vary significantly by geography and underlying liver disease, and these precipitants have a varying impact on patient prognosis. Herein, we present a review of our current understanding of the precipitants of ACLF, including gaps in current data and opportunities for meaningful intervention and areas of future research. Liver Transplantation 26 283-293 2020 AASLD.liveR tRAnsplAntAtion, vol. 26, no. 2, 2020 cullARo et Al.

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“…Patients with HBV flare can succumb to liver failure when there is loss of sufficient liver parenchyma . Multiple extra‐hepatic organ failures can also occur when there is organ damage from the exaggerated inflammation …”

Section: Introductionmentioning

confidence: 99%

The impact of HBV flare on the outcome of HBV‐related decompensated cirrhosis patients with bacterial infection

Cao

Liu

Wang

et al. 2019

Liver International

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Background: Hepatitis B virus (HBV) flare can occur in HBV patients either naïve or have interruption to treatment. Bacterial infection (BI) is a common complication of cirrhosis with potential severe outcomes. We aimed to assess the impact of HBV flare on the outcome of patients with HBV-related decompensated cirrhosis and BI. Methods:This was a retrospective study from 2 tertiary academic hospitals in Shanghai, China of HBV patients admitted with or developed BI during admission.The characteristics of BI, prevalence of HBV flare, its impact on organ failure, acuteon-chronic liver failure (ACLF) and 90-day survival were evaluated.Results: A total of 360 hospitalized patients (median age: 50 years, male: 79%, BI: at admission: 58.6%; during admission: 41.4%) were included. All patients including those with HBV flare (21%) received antiviral therapy after admission. Patients with HBV flare and BI had significantly higher percentage of liver (93.3% vs 48.8%), coagulation (64.0% vs 39.6%), cerebral (40.0% vs 21.8%) (all P < 0.01), and kidney failure (38.7% vs 26.3%, P < 0.05) compared to BI alone, associated with a higher risk of developing ACLF with a subdistribution hazard ratio (sHR) of 2.23 (95% confidence interval [CI]: 1.68-2.96). Multivariate analysis showed that ACLF development was the strongest risk factor for 90-day mortality (sHR, 95%CI: 7.36,). Conclusions:In HBV-related decompensated cirrhosis patients admitted with BI, HBV flare increased the risk of additional organ failures and ACLF, raising the risk

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Characteristics of systemic inflammation in hepatitis B‐precipitated ACLF: Differentiate it from No‐ACLF

Abstract: Systemic inflammation in HB-ACLF was characterized by an excessive innate immune response, which was associated with disease progression and mortality.

Cited by 69 publications

References 26 publications

Characterization of the circulating microbiome in acute‐on‐chronic liver failure associated with hepatitis B

Characterization of the circulating microbiome in acute‐on‐chronic liver failure associated with hepatitis B

Precipitants of Acute‐on‐Chronic Liver Failure: An Opportunity for Preventative Measures to Improve Outcomes

The impact of HBV flare on the outcome of HBV‐related decompensated cirrhosis patients with bacterial infection

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