Nucleoside analogs prevent disease progression in HBV-related acute-on-chronic liver failure: validation of the TPPM model

Wang, Junshuai; Ma, Ke; Han, Meifang; Guo, Wei; Huang, Jiaquan; Yang, Di; Zhao, Xingwei; Song, Jiangxin; Tian, Di; Jiang, Qi; Huang, Yuancheng; Ning, Qin

doi:10.1007/s12072-013-9485-5

Cited by 29 publications

(25 citation statements)

References 39 publications

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“…The recently established and evaluated TPPM model in HBV ACLF patients from a single center large cohort, which displayed a superior predictive ability when compared with MELD and MELD-Na models [n-153]. TPPMs used TBIL, INR, HBV DNA and complications as parameters [153,154]. Based on current multinational cohort, TPPMs demonstrated superiority to CLIF-C OFs, CLIF-C ACLFs, MELDs and MELD-Na in predicting 28-day and 90-day mortality in cirrhotic HBV-ACLF patients [155].…”

Section: Organ Dysfunction and Organ Failure In Aclf For Early Risk Smentioning

confidence: 99%

“…The presence of high HBV DNA [> 10(5) copies/ml/ or > 2 × 10 (4) IU/ml] is highly sensitive and specific for the diagnosis [152]. Early and rapid reduction of HBV DNA is the essence of therapy [153]. Several studies have indicated that if the reduction in DNA of > 2 logs could be achieved within 2 weeks, the survival could be improved.…”

Section: Antiviral Strategies In Aclf Hbv Reactivationmentioning

confidence: 99%

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Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

et al. 2019

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The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the “APASL ACLF Research Consortium (AARC)” was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during the interim period were carefully analyzed and areas of contention and new developments in the field of ACLF were prioritized in a systematic manner. The AARC database was also approached for answering some of the issues where published data were limited, such as liver failure grading, its impact on the ‘Golden Therapeutic Window’, extrahepatic organ dysfunction and failure, development of sepsis, distinctive features of acute decompensation from ACLF and pediatric ACLF and the issues were analyzed. These initiatives concluded in a two-day meeting in October 2018 at New Delhi with finalization of the new AARC consensus. Only those statements, which were based on evidence using the Grade System and were unanimously recommended, were accepted. Finalized statements were again circulated to all the experts and subsequently presented at the AARC investigators meeting at the AASLD in November 2018. The suggestions from the experts were used to revise and finalize the consensus. After detailed deliberations and data analysis, the original definition of ACLF was found to withstand the test of time and be able to identify a homogenous group of patients presenting with liver failure. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information and areas requiring future studies are presented here.

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Section: Organ Dysfunction and Organ Failure In Aclf For Early Risk Smentioning

confidence: 99%

Section: Antiviral Strategies In Aclf Hbv Reactivationmentioning

confidence: 99%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

et al. 2019

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“…During follow-up, all patients received nucleotide/nucleoside analogue antiviral treatment with entecavir, telbivudine, lamivudine, or lamivudine combined with adefovir dipivoxil, which could prevent disease progression and would not affect the short-term prognosis for patients in the current study. [7,8] All patients were followed up for 3 months or longer to assess the 3-month mortality.…”

Section: Methodsmentioning

confidence: 99%

Albumin-bilirubin (ALBI) score at admission predicts possible outcomes in patients with acute-on-chronic liver failure

Chen

Lin²

2017

Medicine

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The albumin-bilirubin (ALBI) score is a new model for assessing the severity of liver dysfunction. The purpose of the present study is to investigate the prognostic value of the ALBI score in predicting the 3-month outcome of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (AoCLF).This study included 84 patients with HBV-AoCLF, 56 chronic hepatitis B (CHB) patients, and 48 healthy controls (HCs). The virological parameters and biochemical examination of blood were obtained after 12 hours of fasting. The follow-up of AoCLF patients lasted for at least 3 months, and the relationships between the prognosis and ALBI score were analyzed.A significantly higher ALBI score was detected in AoCLF patients than in the HC and CHB groups (both P = .001). The ALBI score was positively correlated with the model of the end-stage liver disease (MELD) score and Child–Pugh score. Moreover, ALBI scores were higher among non-survivors than survivors in AoCLF patients. Multivariate analysis suggested that both the ALBI and MELD scores were independent predictors of the 3-month mortality in AoCLF patients (P < .001).A high ALBI score measured at admission may be used as a predictor for the 3-month mortality rate in patients with HBV-AoCLF.

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“…In Europe, the accuracy of the chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score has been validated, as has the MELD score, for predicting short-term mortality in cirrhotics with acute decompensation [12]. Recently, a TPPM scoring system established by Ning's group with reference to and based on MELD, taking complications, number of organ failures and HBV viral load into consideration, was confirmed to have superior predictive value for HBV-ACLF patients when compared with MELD, and it was further validated in another HBV-ACLF cohort [24,31]. The TPPM scoring system was established based on a population of 531 HBV-ACLF patients from Tongji Hospital (Wuhan).…”

Section: Predictive Models For Organ Failures In Aclfmentioning

confidence: 99%

“…Recent studies demonstrated that treatment with nucleoside analogs including entecavir, lamivudine and telbivudine prevented disease progression and increased the survival of patients with HBV-ACLF [24,31]. Data also showed that the shortterm mortality could be reduced if HBV DNA decreases more than 2 logs within 2 weeks [36,37].…”

Section: Antiviral Treatment For Hbv-related Aclfmentioning

confidence: 99%

Definition of ACLF and inclusion criteria for extra-hepatic organ failure

2015

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A prominent characteristic of ACLF is rapid hepatic disease progression with subsequent extra-hepatic organ failure, manifesting as either hepatic coma or hepatorenal syndrome, which is associated with a high mortality rate in a short time. The APASL definition mainly emphasizes recognizing patients with hepatic failure. These patients may subsequently develop extra-hepatic multisystem organ failure leading to high mortality. It is therefore worthwhile to identify the short interim period between the development of liver failure and the onset of extra-hepatic organ failure, the potential therapeutic 'golden window.' Interventions during this period may prevent the development of complications and eventually change the course of the illness. Organ failure is suggested to be a central component of ACLF and may behave differently from chronic decompensated liver disease. Clear and practical criteria for the inclusion of organ failure are urgently needed so that patients with these life-threatening complications can be treated in a timely and appropriate manner. Recent studies suggested that the scoring systems evaluating organ failure [acute physiology, age and chronic health evaluation (APACHE) and sequential organ failure assessment (SOFA) scores] work better than those addressing the severity of liver disease [Child-Pugh and model of end-stage liver disease (MELD) scores] in ACLF. However, a key problem remains that the former scoring systems are reflective of organ failure and not predictive, thus limiting their value as an early indication for intervention.

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Nucleoside analogs prevent disease progression in HBV-related acute-on-chronic liver failure: validation of the TPPM model

Cited by 29 publications

References 39 publications

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

Albumin-bilirubin (ALBI) score at admission predicts possible outcomes in patients with acute-on-chronic liver failure

Definition of ACLF and inclusion criteria for extra-hepatic organ failure

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