Prognostic value of decline in model for end-stage liver disease score and hepatic encephalopathy in hepatitis B-related acute-on-chronic liver failure patients treated with plasma exchange

Zhu, Shu; Liu, Ying; Zheng, Liang; Xu, Wenxiong; Luo, Qiumin; Zhang, Yeqiong; Deng, Hong; Li, Xinhua; Xie, Chengzhi; Peng, Liang

doi:10.1080/00365521.2022.2063032

Cited by 2 publications

(3 citation statements)

References 23 publications

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“…28 Moreover, a study found that HE was a strong independent risk factor for MELD score decline at 1 week, which was associated with a poor short-term prognosis in HBV-related ACLF. 29 There were several limitations in this study. First, this singlecenter study recruited a relatively small number of patients.…”

Section: Discussionmentioning

confidence: 91%

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Safety and efficacy of double plasma molecular adsorption system with sequential low‐volume plasma exchange in intermediate‐stage hepatitis B virus‐related acute‐on‐chronic liver failure

Zhu

Yang

et al. 2023

Journal of Medical Virology

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Current evidence suggests that the mortality rate of intermediate-stage hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) remains high. We aimed to investigate the safety and efficacy of double plasma molecular adsorption system (DPMAS) with sequential low-volume plasma exchange (LPE) treatment in intermediate-stage HBV-related ACLF. This prospective study recruited intermediate-stage HBV-related ACLF patients and was registered on ClinicalTrials.gov (NCT 04597164). Eligible patients were randomly divided into a trial group and a control group. Patients in both groups received comprehensive medical treatment. Patients in the trial group further received DPMAS with sequential LPE. Data were recorded from baseline to Week 12. Fifty patients with intermediate-stage HBV-related ACLF were included in this study. The incidence ofbleeding events and allergic reactions in the trial group was 12% and 4%, respectively, with no other treatment-related adverse events. The levels of total bilirubin and prothrombin time-international normalized ratio, and model for endstage liver disease scores after each session of DPMAS with sequential LPE were significantly lower than those before treatment (all p < 0.05). The 12-week cumulative liver transplantation-free survival rates in the trial and control groups were 52% and 24%, respectively (p = 0.041). The 12-week cumulative overall survival rates in the trial and control groups were 64% and 36%, respectively (p = 0.048). The Kaplan-Meier survival analysis revealed significant differences in liver transplantation-free survival (p = 0.047) and overall survival (p = 0.038) between the trial and control groups. Cox regression analysis indicated that blood urea nitrogen (p = 0.038), DPMAS with sequential LPE (p = 0.048), and Chinese Group on the Study of Severe Hepatitis B-ACLF II score (p < 0.001) were significant risk factors

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Section: Discussionmentioning

confidence: 91%

“…Interestingly, HE was identified as an independent predictor of 90‐day mortality in patients with HBV‐related ACLF 28 . Moreover, a study found that HE was a strong independent risk factor for MELD score decline at 1 week, which was associated with a poor short‐term prognosis in HBV‐related ACLF 29 …”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of double plasma molecular adsorption system with sequential low‐volume plasma exchange in intermediate‐stage hepatitis B virus‐related acute‐on‐chronic liver failure

Zhu

Yang

et al. 2023

Journal of Medical Virology

Self Cite

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“…Thus, the clinically easy-to-measure parameter of HE could be an important prognostic factor in predicting in-hospital mortality and could also influence subsequent treatment decisions. In line, Verma and colleagues just recently described a dynamic assessment of HE, as well as ammonia levels as a predictor of mortality in acute-on-chronic liver failure (ACLF) [44], and Wang and co-workers identified a prognostic value of HE in HBVrelated ACLF patients treated with plasma exchange [45].…”

Section: Variablementioning

confidence: 93%

Clinical determinants of hospital mortality in liver failure: a comprehensive analysis of 62,717 patients

et al. 2023

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Background Liver failure (LF) is characterised by a loss of the synthetic and metabolic liver function and is associated with a high mortality. Large-scale data on recent developments and hospital mortality of LF in Germany are missing. A systematic analysis and careful interpretation of these datasets could help to optimise outcomes of LF. Methods We used standardised hospital discharge data of the Federal Statistical Office to evaluate current trends, hospital mortality and factors associated with an unfavourable course of LF in Germany between 2010 and 2019. Results A total of 62,717 hospitalised LF cases were identified. Annual LF frequency decreased from 6716 (2010) to 5855 (2019) cases and was higher among males (60.51%). Hospital mortality was 38.08% and significantly declined over the observation period. Mortality significantly correlated with patients’ age and was highest among individuals with (sub)acute LF (47.5%). Multivariate regression analyses revealed pulmonary (ORARDS: 2.76, ORmechanical ventilation: 6.46) and renal complications (ORacute kidney failure: 2.04, ORhepatorenal syndrome: 2.92) and sepsis (OR: 1.92) as factors for increased mortality. Liver transplantation reduced mortality in patients with (sub)acute LF. Hospital mortality significantly decreased with the annual LF case volume and ranged from 47.46% to 29.87% in low- or high-case-volume hospitals, respectively. Conclusions Although incidence rates and hospital mortality of LF in Germany have constantly decreased, hospital mortality has remained at a very high level. We identified a number of variables associated with increased mortality that could help to improve framework conditions for the treatment of LF in the future.

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Prognostic value of decline in model for end-stage liver disease score and hepatic encephalopathy in hepatitis B-related acute-on-chronic liver failure patients treated with plasma exchange

Cited by 2 publications

References 23 publications

Safety and efficacy of double plasma molecular adsorption system with sequential low‐volume plasma exchange in intermediate‐stage hepatitis B virus‐related acute‐on‐chronic liver failure

Safety and efficacy of double plasma molecular adsorption system with sequential low‐volume plasma exchange in intermediate‐stage hepatitis B virus‐related acute‐on‐chronic liver failure

Clinical determinants of hospital mortality in liver failure: a comprehensive analysis of 62,717 patients

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