Early predictors of acute hepatitis B progression to liver failure

Abstract

Background and aims1~4% of acute hepatitis B (AHB) cases in adults progresses to acute liver failure (ALF).The predictors of ALF and prognosis for patients with ALF are not clear. This study investigated some of predictive and prognostic factors for AHB progression to ALF.MethodsA retrospective analysis was used to assess the clinical and laboratory features of 293 patients diagnosed with AHB; the patients were divided into the following two groups: ALF (n = 13) and non-ALF (n = 280).ResultsIn total,13 of the 293 (4.43%) patients developed ALF (10 recovered、3 died). The variables of age, anti-HBc IgM titers≥10 S/CO, HBeAg negativity, and total bilirubin (TB) at admission were significantly higher in ALF patients than in non-ALF patients. Compared to non-ALF patients, ALF patients had significantly lower values for prothrombin time activity (PTA), serum albumin, and HBV DNA. At discharge, ALF patients had lower TB normalization rates and much faster clearance of HBsAg, HBeAg and HBVDNA than non-ALF patients. In multivariate analysis, TB≥5×upper limit of normal (ULN) and HBeAg negative status were independent predictors for ALF development at admission, with 84.6% sensitivity, 85.7% specificity, a likelihood ratio of 5.91 and an area under the receiver operating characteristics curve (AUROC) of 0.850.Those who died had lower levels of peak PTA (<20%) and higher levels of peak hepatic encephalopathy (HE) grade (III-IV) than those who recovered.ConclusionsOf the patients with ALF, 23.1% died. TB≥5×ULN and HBeAg negative status were the most effective and practicable factors distinguishing ALF from AHB at admission before the onset of encephalopathy. Peak PTA<20% and/or HE grade III-IV were independent predictors of a high probability of death or a need for transplantation.

Acute Liver Failure Prognostic Criteria: It's Time to Revisit

“…Hepatic encephalopathy was found to be a predictor of mortality in various studies. Xiong et al [ 18 ] demonstrated that a hepatic encephalopathy of grade 3 or 4 was associated with poor outcomes, and Mainardi et al [ 12 ] concluded that the mortality rate is 94% in patients with a higher grade of hepatic encephalopathy (grade 3 or 4). In this study mortality rate is 60.0% in grade 3 or grade 4 hepatic encephalopathy in patients with ALF.…”

Mesenchymal stem cells-based therapy in liver diseases

“…Symptoms of acute hepatitis C virus (HCV) infection are usually subclinical, whereas acute hepatitis B virus (HBV) infection tends to result in symptomatic hepatitis in adults, with patients' clinical presentation ranging from asymptomatic to fulminant liver failure [ 105 , 106 ]. Data show that 23.1% of patients with acute viral hepatitis B-related acute liver failure eventually die [ 107 ].…”

Patient With Nonalcoholic Steatohepatitis Posttransplant Develops Acute Hepatitis B Virus Causing Graft Failure

“…Acute hepatitis B can progress to ALF in 1% to 4% of cases . In particular, ALF caused by HBV infection in an immunosuppressant state can be fatal .…”

“…Liver transplant is the only known definitive treatment for ALF, with survival at 1 year ranging from 50% to 75% . One study by Xiong et al identified peak prothrombin time activity less than 20% (low) and grade III‐IV hepatic encephalopathy as independent predictors requiring LT or high risk for mortality …”

“…Due to persistent evidence of graft failure (elevated liver function tests combined with coagulopathy and hepatic encephalopathy), she underwent urgent evaluation for retransplantation, resulting in listing for a second liver transplant. She experienced acute renal failure requiring continuous renal replacement therapy, and her condition deteriorated to needing intensive care unit stay; she received her second transplant 10 days later.aCUTe HePaTiTis B anD liver FailUreAcute hepatitis B can progress to ALF in 1% to 4% of cases 1. In particular, ALF caused by HBV infection in anFIG 1 Laboratory data overview, part 1.FIG 2 Laboratory data overview, part 2.…”