Risk factors for progression to acute-on-chronic liver failure during severe acute exacerbation of chronic hepatitis B virus infection

Abstract

BACKGROUND Acute exacerbation in patients with chronic hepatitis B virus (HBV) infection results in different severities of liver injury. The risk factors related to progression to hepatic decompensation (HD) and acute-on-chronic liver failure (ACLF) in patients with severe acute exacerbation (SAE) of chronic HBV infection remain unknown. AIM To identify risk factors related to progression to HD and ACLF in compensated patients with SAE of chronic HBV infection. METHODS The baseline characteristics of 164 patients with SAE of chronic HBV infection were retrospectively reviewed. Independent risk factors associated with progression to HD and ACLF were identified. The predictive values of our previously established prediction model in patients with acute exacerbation (AE model) and the model for end-stage liver disease (MELD) score in predicting the development of ACLF were evaluated. RESULTS Among 164 patients with SAE, 83 (50.6%) had compensated liver cirrhosis (LC), 43 had progression to HD without ACLF, and 29 had progression to ACLF within 28 d after admission. Independent risk factors associated with progression to HD were LC and low alanine aminotransferase. Independent risk factors for progression to ACLF were LC, high MELD score, high aspartate aminotransferase (AST) levels, and low prothrombin activity (PTA). The area under the receiver operating characteristic of the AE model [0.844, 95% confidence interval (CI): 0.779-0.896] was significantly higher than that of MELD score (0.690, 95%CI: 0.613-0.760, P < 0.05) in predicting the development of ACLF. CONCLUSION In patients with SAE of chronic HBV infection, LC is an independent risk factor for progression to both HD and ACLF. High MELD score, high AST, and low PTA are associated with progression to ACLF. The AE model is a better predictor of ACLF development in patients with SAE than MELD score.

A prognostic score for patients with acute-on-chronic liver failure treated with plasma exchange-centered artificial liver support system

“…These findings help to explain the positive correlations between 3-month prognosis and TBil, PT-INR, infection, HE, as well as PALS model and its simplified PALS score. Although contradictory results between the presence of LC and the progress or prognosis of ACLF have been reported previously 36 – 38 , our study do find that the presence of LC is an independent prognostic risk factor for patients with ACLF along with other studies 39 – 41 . However, the possible negative correlation between age and prognosis was not found in our study even though age was reported to be an independent risk factor in predicting development of ACLF 36 , 38 , and decreased capacity of liver regeneration and impaired immune function were reported in older patients 42 , 43 .…”

Validation of non-invasive tools in predicting HBV-related acute-on-chronic liver failure

“…Among these scoring systems, only MELDs has been evaluated to predict the progression to HBV-related ACLF. Although high MELDs was associated with progression to ACLF, the predictive value of MELDs was not satisfying with the AUROC ranged from 0.601 to 0.820 [1][2][3]9]. There are currently a few specifically designed predictive models for the progression of HBV-related ACLF superior to MELDs.…”

“…The sum risk score ranged from 0 to 7, and 4-7 identified patients with higher risk of ACLF (26.0%-68.8%). Another two prediction models established by Li et al [1] (containing age, PTA, TBIL, bilirubin, Na and HBV DNA) and Yuan et al [2] (containing age and HBV DNA) could predict HBV-related ACLF more effectively than MELDs.…”

“…It has been shown pre-existing liver cirrhosis, patient age, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), prothrombin activity (PTA) or international normalized ratio (INR) of prothrombin time (PT), albumin (ALB), ammonia, alpha fetoprotein (AFP) and HBV DNA were revealed to be related to the development to HBV-related ACLF [1][2][3]. Nevertheless, most of these clinical biochemical indicators were not specifically designed to predict HBV-related ACLF.…”

Development and Validation of a Novel Risk Prediction Model Using Recursive Feature Elimination Algorithm for Acute-on-Chronic Liver Failure in Chronic Hepatitis B Patients With Severe Acute Exacerbation

“…Predictors were collected using an online electronic case report form, and their integrity was systematically checked before being entered into the model. We selected the predictors from the electronic health records based on published literature (27)(28)(29) and our clinical experience. Baseline data were the data obtained at the first diagnosis of SAE of CHB from the computerized and paper medical records.…”