Risk factors and prognostic model for HBV-related subacute liver failure

Abstract

Background:The prognosis for patients with chronic hepatitis B virus (HBV)-related subacute liver failure is poor. Thus, accurate prognostication would facilitate management and optimize liver allocation. This study aimed to explore the risk factors for HBV-related subacute liver failure and establish a risk model. Methods: A total of 192 patients with HBV-related subacute liver failure treated at the First Affiliated Hospital of Xi'an Jiaotong University during January 2018 to January 2019 were selected and divided into the survival group (n=113) and the death group (n=79) based on their status within 6 months. Patient information were collected, including age, sex, body mass index, complications, hepatitis B e antigen (HBeAg), hepatic encephalopathy, hepatorenal syndrome, infections, ascites, HBV-DNA, Model for End-Stage Liver Disease (MELD), liver function tests, international normalized ratio (INR), serum creatinine and total cholesterol. Binary logistic regression was employed to identify risk factors for risk model establishment. The predictive value of the risk model was assessed with a receiver operating characteristic (ROC) curve. Results: Compared with the survival group, the patient age, incidence of hepatic encephalopathy and hepatorenal syndrome, infection and ascites rate, MELD score, and alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), INR, and serum creatinine levels were significantly elevated, whereas the total cholesterol level was significantly decreased in the death group (all P<0.05). Patient age [odds ratio (OR) =1.11, P=0.03], hepatic encephalopathy (OR =8.31, P=0.02), infection (OR =4.27, P=0.005), ascites (OR =4.54, P=0.006), MELD score (OR =1.39, P<0.001), INR (OR =5.89, P=0.001), and total cholesterol (OR =0.31, P=0.002) were identified as prognostic factors affecting patient mortality. Although both the MELD score and the risk model established in the present study could differentiate patient outcomes, the area under the curve (AUC) (0.94 vs. 0.82, P<0.001) and sensitivity (91.1% vs. 58.2%, P<0.001) of the established risk model were significantly higher than those of the MELD score. Conclusions: Patient age, hepatic encephalopathy, infection, ascites, MELD score, INR, and total cholesterol level were independent prognostic factors. The prognostic model established based on these risk factors may have favorable predictive value.

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

“…Interestingly, in a recent study evaluating patients with liver cirrhosis but not liver failure, ARDS was not independently associated with increased mortality [36]. In contrast to a recent report evaluating risk factors for an increased mortality in hepatitis B virus (HBV)-related subacute liver failure [37], only the presence of spontaneous bacterial peritonitis (SBP) but not ascites alone was associated with an increased hospital mortality in our analyses. Thus, infectious complications in particular seem to be a major influence factor on hospital mortality and should be avoided or aggressively treated.…”

Changes in TNF-α, IL-33, and MIP-1α before and after artificial liver support treatment and their prognostic value

“…Serious complications include yellowing of the skin (jaundice), ascites, coagulation disorders, hydroelectrolyte disorders, and hepatic encephalopathy [2]. ACLF (acute-on-chronic liver failure) is a specific type of liver failure [3], characterized by a relatively slower progression of liver injury and failure, typically over a few weeks to a few months [4]. This contrasts with acute liver failure, which exhibits a rapidly progressive course, often revealing severe liver impairment within days.…”