Low high-density lipoprotein cholesterol levels predicting poor outcomes in patients with hepatitis B virus-related acute-on-chronic liver failure

Zhang, Yue; Chen, Peng; Zhang, Yun; Nie, Yuan; Zhu, Xuan

doi:10.3389/fmed.2022.1001411

Cited by 7 publications

(3 citation statements)

References 25 publications

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“…Moreover, it has been found that hemoglobin could not only identify individuals at high risk of developing ACLF but also serve as a strong predictor in the survival rate of patients with cirrhosis, 47 poor outcomes in HBV-ACLF patients, low high-density lipoprotein cholesterol levels also played an important role in the pathophysiology of systemic in ammation driving the onset of ACLF. 49,50 Consistent with these ndings, our study also found that HDL-C < 0.5 mmol/L was a robust predictor for ACLF progression.…”

Section: Main Ndingssupporting

confidence: 86%

Early Prediction of Acute-on-Chronic Liver Failure Development in patients with diverse chronic liver diseases

Shen,

Xu,

Chen

et al. 2024

Preprint

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Background & aims: Acute-on-chronic liver failure (ACLF) is a syndrome characterized by the acute decompensation of chronic liver disease, leading to organ failures and high short-term mortality. The course of ACLF is dynamic and reversible in a considerable proportion of patients during hospital admission. Early detection and accurate assessment of ACLF are crucial, yet ideal methods remain lacking. Therefore, this study is aimed to develop a new score for predicting the onset of ACLF in patients with diverse chronic liver diseases. Methods: A total of 6188 patients with diverse chronic liver diseases were included in the study. Clinical and laboratory data were collected, and the occurrence of ACLF within 28 days was recorded. Lasso-cox regression was utilized to establish prediction models for the development of ACLF at 7, 14, and 28 days. Findings: Among 5221 patients without ACLF, 477 patients progressed to ACLF within 28 days. Seven predictors were found to be significantly associated with the occurrence of ACLF at 7, 14, and 28 days. The new score had the best discrimination with the c-index of 0.958, 0.944, and 0.938 at 7, 14, and 28 days, respectively, outperforming those of four other scores(CLIF-C-ACLF-Ds, MELD, MELD-Na, and CLIF-C-ADs score, all P<0 .001). The new score also showed improvements in predictive accuracy, time-dependent receiver operating characteristics, probability density function evaluation, and calibration curves, making it highly predictive for the onset of ACLF at all time points. The optimal cut-off value (9.6) differentiated high and low-risk patients of ACLF onset. These findings were further validated in a separate group of patients. Conclusion: A new progressive score, based on seven predictors, has been developed to accurately predict the occurrence of ACLF within 7, 14, and 28 days in patients with diverse chronic liver diseases and might be used to identify high-risk patients, customize follow-up management, and guide escalation of care, prognostication, and transplant evaluation.

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Section: Main Ndingssupporting

confidence: 86%

Early Prediction of Acute-on-Chronic Liver Failure Development in patients with diverse chronic liver diseases

Shen,

Xu,

Chen

et al. 2024

Preprint

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“…Importantly, this new scoring model fills a gap in predictive models specific to ACLF triggered by HEV infection. However, this does not mean that dyslipidemia is related only to the disease caused by HEV, as previous studies have shown that lipids or their metabolic disorder were associated with stratification of severe hepatitis diseases in other cohorts [ 15 , 29 , 30 ] and have indicated poor prognosis [ 31 , 32 ]. In contrast, dyslipidemia may be the common pathophysiological response of ACLF.…”

Section: Discussionmentioning

confidence: 99%

A new dyslipidemia-based scoring model to predict transplant-free survival in patients with hepatitis E-triggered acute-on-chronic liver failure

Chen

Zhu

et al. 2023

Lipids Health Dis

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Background/Aims Hepatitis E virus (HEV)-triggered acute-on-chronic liver failure (ACLF) has unacceptably high short-term mortality. However, it is unclear whether the existing predictive scoring models are applicable to evaluate the prognosis of HEV-triggered ACLF. Methods We screened datasets of patients with HEV-triggered ACLF from a regional tertiary hospital for infectious diseases in Shanghai, China, between January 2011 and January 2021. Clinical and laboratory parameters were recorded and compared to determine a variety of short-term mortality risk factors, which were used to develop and validate a new prognostic scoring model. Results Out of 4952 HEV-infected patients, 817 patients with underlying chronic liver disease were enrolled in this study. Among these, 371 patients with HEV-triggered ACLF were identified and allocated to the training set (n = 254) and test set (n = 117). The analysis revealed that hepatic encephalopathy (HE), ascites, triacylglycerol and apolipoprotein A (apoA) were associated with 90-day mortality (P < 0.05). Based on these significant indicators, we designed and calculated a new prognostic score = 0.632 × (ascites: no, 1 point; mild to moderate, 2 points; severe, 3 points) + 0.865 × (HE: no, 1 point; grade 1–2, 2 points; grade 3–4, 3 points) − 0.413 × triacylglycerol (mmol/L) − 2.171 × apoA (g/L). Compared to four well-known prognostic models (MELD score, CTP score, CLIF-C OFs and CLIF-C ACLFs), the new scoring model is more accurate, with the highest auROCs of 0.878 and 0.896, respectively, to predict 28- and 90-day transplantation-free survival from HEV-triggered ACLF. When our model was compared to COSSH ACLF IIs, there was no significant difference. The test data also demonstrated good concordance. Conclusions This study is one of the first to address the correlation between hepatitis E and serum lipids and provides a new simple and efficient prognostic scoring model for HEV-triggered ACLF.

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“…Interestingly, a previous study found hypercholesterolemia was associated with well-preserved hepatic function and decreased mortality in patients with cirrhosis ( 32 ). On the other hand, a recent study showed that HBV-ACLF patients with lower high-density lipoprotein cholesterol level had a worse prognosis than those with higher HDL-C levels ( 33 ). Increased age also raises the risk of mortality due to a higher incidence of comorbidities and poor hepatic regeneration in response to acute insults ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

ALTA: a simple nutritional prognostic score for patients with hepatitis B virus-related acute-on-chronic liver failure

Song,

Wang,

et al. 2024

Front. Nutr.

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BackgroundMalnutrition, despite being a common complication, is often neglected in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). The objective of this study was to develop a simplified nutritional prognostic score to accurately predict mortality in HBV-ACLF patients.MethodsIn this multicenter retrospective study, clinical data from 530 HBV-ACLF patients were used to create a new prognostic score, which was then validated in two external cohorts (n = 229 and 248).ResultsFour independent factors were significantly associated with 28-day mortality in HBV-ACLF patients, forming a novel prognostic score (ALTA score = 0.187 × age—0.849 × lymphocyte count—2.033 × total cholesterol—0.148 × albumin—0.971). Notably, the AUROC of ALTA score for 28/90-day mortality (0.950/0.967) were significantly higher than those of three other ACLF prognostic scores (COSSH-ACLF II, 0.864/0.734; MELD, 0.525/0.488; MELD-Na, 0.546/0.517; all P < 0.001), and three known nutritional scores (CONUT, 0.739/0.861; OPNI, 0.279/0.157; NRS-2002, 0.322/0.286; all P < 0.001). The prediction error rates of ALTA score for 28-day mortality were significantly lower than COSSH-ACLF II (7.3%), MELD (14.4%), MELD-Na (12.7%), CONUT (9.0%), OPNI (30.6%), and NRS2002 (34.1%) scores. Further classifying ALTA score into two strata, the hazard ratios of mortality at 28/90 days were notably increased in the high-risk groups compared to the low-risk group (15.959 and 5.740). These results were then validated in two external cohorts.ConclusionALTA, as a simplified nutritional prognostic score for HBV-ACLF, demonstrates superiority over the COSSH-ACLF II and other scores in predicting short-term mortality among HBV-ACLF patients. Therefore, it may be used to guide clinical management, particularly in primary care settings.

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Low high-density lipoprotein cholesterol levels predicting poor outcomes in patients with hepatitis B virus-related acute-on-chronic liver failure

Cited by 7 publications

References 25 publications

Early Prediction of Acute-on-Chronic Liver Failure Development in patients with diverse chronic liver diseases

Early Prediction of Acute-on-Chronic Liver Failure Development in patients with diverse chronic liver diseases

A new dyslipidemia-based scoring model to predict transplant-free survival in patients with hepatitis E-triggered acute-on-chronic liver failure

ALTA: a simple nutritional prognostic score for patients with hepatitis B virus-related acute-on-chronic liver failure

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