Complications constitute a major risk factor for mortality in hepatitis B virus-related acute-on-chronic liver failure patients: a multi-national study from the Asia–Pacific region

Chen, Tao; Yang, Zhongyuan; Choudhury, Ashok; Mahtab, Mamun Al; Li, Jun; Chen, Yu; Tan, Soek Siam; Han, Tao; Hu, Jinhua; Salehiniya, Hamid; Huei, Lee Guan; Ghazinian, Hasmik; Nan, Yuemin; Chawla, Yogesh; Yuen, Man Fung; Devarbhavi, Harshad; Shukla, Akash; Abbas, Zaigham; Sahu, Manoj Kumar; Dokmeci, A. Kadir; Lesmana, Laurentias A.; Lesmana, Cosmas Rinaldi Adithya; Xin, Shaojie; Duan, Zhongping; Guo, Wei; Ma, Ke; Zhang, Zhongwei; Cheng, Qi; Jia, Jidong; Sharma, Barjesh Chander; Sarin, Shiv Kumar; Ning, Qin

doi:10.1007/s12072-019-09992-x

Cited by 43 publications

(37 citation statements)

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“…Thus, the first 3 months played a major role in the long-term prognosis of ACLF. 25,26 Because HBV-ACLF was likely to be precipitated by virus relapse and mutation resistance, nucleoside analogue antiviral therapy has been recognized as an essential treatment. ALSS has always been considered a bridge treatment to liver transplantation in ACLF patients; however, because of the differences in the baseline characteristics of patients, the potential importance of ALSS is still controversial.…”

Section: Discussionmentioning

confidence: 99%

Effect of artificial liver support system on short‐term prognosis of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

et al. 2020

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Hepatitis B virus‐related acute‐on‐chronic liver failure (HBV‐ACLF) is difficult to treat and carries a high risk of short‐term mortality. This study aimed to explore the effect of artificial liver support system (ALSS) on the survival of HBV‐ACLF patients and to investigate which HBV‐ACLF patients may benefit from ALSS treatment. We enrolled 132 patients hospitalized for HBV‐ACLF according to the criteria of the Chinese Group on the Study of Severe Hepatitis B‐ACLF (COSSH‐ACLF) from 425 ACLF patients who were determined to at least meet the Asian Pacific Association for the Study of the Liver criteria and followed up for 90 days. Overall 132 eligible patients were divided into two groups: standard medical treatment (SMT) group, which included 54 patients who underwent SMT alone, and ALSS group, which included 78 patients who underwent ALSS treatment plus SMT. The proportion of HBV‐ACLF grade 1, 2, and 3 was 57.69%, 37.18%, and 5.13% in the ALSS group and 51.85%, 35.19%, and 12.96% in the SMT group, respectively. Bacterial infection was present in 43.6% of patients in the ALSS group and in 55.6% of patients in the SMT group. The mortality rates in the ALSS group at 28 and 90 days were significantly lower than those in the SMT group (23.08% vs. 48.15% and 33.33% vs. 57.41%, P < 0.05). ALSS was an independent factor related to both the 28‐ and 90‐day survival of HBV‐ACLF patients. Particularly, a higher cumulative survival rate in either patients with HBV‐ACLF grade 1 or those with HBV‐ACLF with bacterial infection was observed in the ALSS group. Moreover, ALSS had an independent influence on mortality. Based on the COSSH‐ACLF criteria, ALSS could better improve the short‐term survival of HBV‐ACLF patients than SMT alone, especially in those with HBV‐ACLF grade 1 or HBV‐ACLF with infection.

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Section: Discussionmentioning

confidence: 99%

Effect of artificial liver support system on short‐term prognosis of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

et al. 2020

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“…A study has investigated the course of patients with ACLF defined by AARC criteria. 21 Almost 80% of patients had complications, including bacterial or fungal infection in 32% of patients, hepatorenal syndrome in 15%, and gastrointestinal hemorrhage in 9%. The 28-day transplantation-free mortality rates was 28%.…”

Section: Aclf Phenotype According To the Aarc Definitionmentioning

confidence: 99%

“…Investigators in Europe, 10 North America 3,38 and Asia 21,39,40 all agree to say that secondary infections are common complications of ACLF. Moreover, among patients with ACLF, 90-day mortality was higher in those who develop secondary infection than in those who remain free of this complication during the entire period of followup, 10,41 indicating the extreme severity of secondary infection in this context.…”

Section: Immunosuppression In Aclfmentioning

confidence: 99%

Acute-on-chronic liver failure: Definitions, pathophysiology and principles of treatment

2021

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“…The result showed that the tolerance of all variables > 0:1 and the variance inflation factor < 5, indicating limited collinearity among the above variables. As the presence of cirrhosis, HBV DNA, and AKI and gender had been reported to be important predictive factors for the prognosis of ACLF [18][19][20][21], those were included in multivariate analysis as well.…”

Section: The Mortality In Overall Study Population and Predictorsmentioning

confidence: 99%

The Risk of Acute Kidney Injury in Hepatitis B Virus-Related Acute on Chronic Liver Failure with Tenofovir Treatment

Zhang

Lin

Wang

et al. 2020

BioMed Research International

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Aims. Tenofovir (TDF) is an antiviral drug with potential risk of kidney injury. The study is aimed at comparing the incidence of acute kidney injury (AKI) between TDF and entecavir (ETV) treatment in hepatitis B virus- (HBV-) related acute on chronic liver failure (ACLF). Methods. Treatment-naive patients with HBV-related ACLF were included. Propensity score matching was used to balance the baseline characteristics between ETV and TDF groups. The risk of AKI and the efficacy of TDF and ETV were compared. Results. A total of 95 cases with HBV-related ACLF were included in this study, with 74.74% of male and a mean age of 47.01±14.71 years. The antiviral therapy was initiated within 2 days after admission, with 39 cases on the TDF group and 56 on the ETV group. Patients in the TDF group had higher AST, hemoglobin, and serum sodium levels and lower MELD-Na score. After propensity matching, 39 cases of TDF and 39 of ETV were included in the final analysis. No difference was found in the changes of creatinine and cystatin C from baseline to 4 weeks after treatment between ETV and TDF groups. AKI was developed in 1 (2.56%) patient in the ETV group and 2 (5.13%) in the TDF group within one month (P=0.556). Survival analysis revealed no significant difference in the 6-month mortality between the two groups (P=0.813). Cox analysis showed that the type of antiviral drug or the development of AKI was not an independent risk factor for the outcomes. Conclusions. Compared to ETV, TDF did not increase the risk of AKI nor the mortality in patients with HBV-related ACLF in the short time.

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Complications constitute a major risk factor for mortality in hepatitis B virus-related acute-on-chronic liver failure patients: a multi-national study from the Asia–Pacific region

Cited by 43 publications

References 25 publications

Effect of artificial liver support system on short‐term prognosis of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

Effect of artificial liver support system on short‐term prognosis of patients with hepatitis B virus‐related acute‐on‐chronic liver failure

Acute-on-chronic liver failure: Definitions, pathophysiology and principles of treatment

The Risk of Acute Kidney Injury in Hepatitis B Virus-Related Acute on Chronic Liver Failure with Tenofovir Treatment

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