Long‐term outcomes of patients with hepatitis B virus‐related acute on chronic liver failure: An observational cohort study

Lin, Su; Zhang, Kai; Zhang, Junchao; Wang, Mingfang; Velani, Bharat; Zhu, Yueyong

doi:10.1111/liv.14072

Cited by 21 publications

(24 citation statements)

References 23 publications

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“…The transition probabilities of the health states were estimated using the equation published previously: P(t) = 1-exp(-µt), P(1 month) = 1-(0.5) (1/median time to event) [20][21][22] (Table 1). [24]. Monthly TACE progression survival was the same with progressive HCC in the data.…”

Section: Base Case Datamentioning

confidence: 79%

Cost-effectiveness analysis of transarterial chemoembolization combined with stereotactic body radiation therapy versus transarterial chemoembolization for inoperable hepatocellular carcinoma: A markov modelling study

Wang¹,

Gc²,

Zhang³

et al. 2020

Preprint

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Background Transarterial chemoembolization (TACE) and Stereotactic body radiation therapy (SBRT) might both provide survival benefits for inoperable hepatocellular carcinoma (HCC). Adopting combined therapy as a solution carries major cost and resource implications. We aimed to estimate the cost-effectiveness of TACE plus SBRT and TACE alone in inoperable HCC. Methods A Markov model was constructed in a hypothetical cohort of patients aged 60 years with inoperable HCC and Child-Pugh A/B cirrhosis over a lifetime frame. Two strategies (TACE plus SBRT and TACE) were compared. Transition probabilities, utility and costs were extracted from published literature. Incremental cost-effectiveness ratios (ICER) were measured. Deterministic and probabilistic sensitivity analyses were conducted to assess the robustness of the findings. Results TACE plus SBRT and TACE respectively produced 12.26 and 9.67 quality-adjusted life years (QALYs). The ICER of TACE plus SBRT versus TACE was $3,133/QALY. One-way sensitivity analysis revealed that the utility of TACE combined with SBRT progress survival, probability of death from progress survival in TACE, and the initial cost of TACE combined with SBRT were the most sensitive parameters. The Monte-Carlo simulation demonstrated that the probability of cost-effectiveness at a willingness to pay threshold of US$ 29,440 per QALY was 95% and 5% for TACE plus SBRT and TACE. Conclusions This study indicated that TACE plus SBRT is cost-effective compared to TACE for inoperable HCC patients at a willingness to pay threshold as defined by WHO guidelines in China.

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Section: Base Case Datamentioning

confidence: 79%

Cost-effectiveness analysis of transarterial chemoembolization combined with stereotactic body radiation therapy versus transarterial chemoembolization for inoperable hepatocellular carcinoma: A markov modelling study

Wang¹,

Gc²,

Zhang³

et al. 2020

Preprint

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“…ACLF was diagnosed based on the guideline of the Asian Pacific Association for the Study of the Liver (2014)[ 23 ], which are the most widely used criteria in Asia[ 24 ]. ACLF was confirmed in patients with chronic liver disease who had a total serum bilirubin ≥ 5 mg/dL or an international normalized ratio of ≥ 1.5 within 4 wk, complicated by encephalopathy and/or ascites[ 23 ].…”

Section: Methodsmentioning

confidence: 99%

Development of a novel score for the diagnosis of bacterial infection in patients with acute-on-chronic liver failure

Lin

Yan

et al. 2020

WJG

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BACKGROUND The diagnosis of bacterial infection is difficult in patients with acute-on-chronic liver failure (ACLF). AIM To evaluate the diagnostic accuracy of widely used parameters for bacterial infection in ACLF and to develop a simple scoring system to improve diagnostic efficiency. METHODS This was a retrospective study. Procalcitonin (PCT), white blood cells (WBC), proportion of neutrophils (N%), and C-reactive protein (CRP) were examined. Logistic regression was used to select variables for the scoring models and receiver operating characteristic curve (ROC) analysis was used to evaluate the diagnostic value of different indices. RESULTS This study included 386 patients with ACLF, 169 (43.78%) of whom had bacterial infection on admission. The area under the ROC (AUROC) of PCT, CRP, WBC and N% for the diagnosis of bacterial infection ranged from 0.637 to 0.692, with no significant difference between them. Logistic regression showed that only N%, PCT, and CRP could independently predict infection. A novel scoring system (infection score) comprised of N%, PCT and CRP was developed. The AUROC of the infection score was 0.740, which was significantly higher than that for the other four indices (infection score vs N%, PCT, CRP, and WBC, P = 0.0056, 0.0001, 0.0483 and 0.0008, respectively). The best cutoff point for the infection score was 4 points, with a sensitivity of 78.05%, a specificity of 55.29%, a positive predictive value of 57.91% and a negative predictive value of 76.16%. CONCLUSION The infection score is a simple and useful tool for discriminating bacterial infection in ACLF.

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“…Acute on chronic liver failure (ACLF) is defined as a precipitating event in a patient with chronic liver disease, leading to jaundice and coagulopathy complicated by clinical ascites and/or encephalopathy [3]. Patients with ACLF due to HBV reactivation (HBV-ACLF) have extremely poor prognosis, with a reported short-term mortality ranging from 29.7% to 40% within 28 days [4][5][6]. Acute kidney injury (AKI) is common in ACLF and may develop within a very short period and lead to a poor outcome in ACLF [7].…”

Section: Introductionmentioning

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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Long‐term outcomes of patients with hepatitis B virus‐related acute on chronic liver failure: An observational cohort study

Cited by 21 publications

References 23 publications

Cost-effectiveness analysis of transarterial chemoembolization combined with stereotactic body radiation therapy versus transarterial chemoembolization for inoperable hepatocellular carcinoma: A markov modelling study

Cost-effectiveness analysis of transarterial chemoembolization combined with stereotactic body radiation therapy versus transarterial chemoembolization for inoperable hepatocellular carcinoma: A markov modelling study

Development of a novel score for the diagnosis of bacterial infection in patients with acute-on-chronic liver failure

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

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