Stratified alpha-fetoprotein pattern accurately predicts mortality in patients with acute-on-chronic hepatitis B liver failure

Huang, Guiqian; Xie, Yaoyao; Zhu, Pei-Wu; Wang, Xiaodong; Lin, Zhuo; Wang, Yan; Ye, Jiang-Pin; Wang, Yumin; Chen, Yingxiao; Jin, Xiaozhi; Poucke, Sven Van; Chen, Yongping; Zheng, Ming‐Hua

doi:10.1080/17474124.2018.1424540

Cited by 6 publications

(9 citation statements)

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“…AFP has been widely used as a clinical biomarker of chronic liver diseases and hepatic malignancy . Huang et al suggested that AFP is a marker of liver regeneration, whereby a high AFP was associated with greater hepatocyte regeneration and favorable outcomes in patients with HBV‐ACLF. Kakisaka et al suggested that serum AFP level may reflect the induction of liver progenitor cells in acute liver failure patients, and the persistent induction of liver progenitor cells may be needed for a recovery from liver failure.…”

Section: Discussionmentioning

confidence: 99%

A prognostic model for hepatitis B acute‐on‐chronic liver failure patients treated using a plasma exchange‐centered liver support system

Xie

Violetta

Chen

et al. 2019

J of Clinical Apheresis

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Aim: To determine the prognostic risk factors of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) treated with plasma exchange (PE)-based artificial liver support system (ALSS), and create a prognostic predictive model. Methods:A total of 304 HBV-ACLF patients who received PE-based ALSS were retrospectively analyzed. Potential prognostic factors on admission associated with survival were investigated. Of note, 101 additional patients were analyzed to validate the performance of the prognostic models.Results: According to 28-day survival, a total of 207 patients who survived and 97 non-survivors were identified in the derivation group. Overall, 268 (88.2%) ACLF cases were caused by reactivation of HBV. Cox proportional hazards regression model revealed that age, total bilirubin, ln (alphafetoprotein [AFP]), encephalopathy (HE) score, sodium level, and international normalized ratio (INR) were independent risk factors of short-term prognosis. We built a model named ALSS-prognosis model (APM) to predict the 28-day survival of HBV-ACLF patients with ALSS; the model APM showed potentially better predictive performance for both the derivation and validation groups than MELD, MELD-Na, and CLIF-C ACLF score.Conclusions: Low AFP was found to be an independent risk factor for high mortality in HBV-ACLF patients treated with PE-based ALSS. We generated a new model containing AFP, namely APM, which showed potentially better prediction performance than MELD, MELD-Na, and CLIF-C ACLF score for short-term outcomes, and could aid physicians in making optimal therapeutic decisions. K E Y W O R D S AFP, ALSS, HBV-ACLF, plasma exchange Zhongyang Xie and Laurencia Violetta contributed equally to this study.

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Section: Discussionmentioning

confidence: 99%

A prognostic model for hepatitis B acute‐on‐chronic liver failure patients treated using a plasma exchange‐centered liver support system

Xie

Violetta

Chen

et al. 2019

J of Clinical Apheresis

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“…Based on these previous studies, whether Gc and AFP might serve as useful prognostic markers for ALF remains uncertain. Acute on chronic liver failure represents a distinct patient population that has also been evaluated with similar results …”

Section: Introductionmentioning

confidence: 99%

Changes in alpha‐foetoprotein and Gc‐globulin in relation to outcomes in non‐acetaminophen acute liver failure

Singh

Hynan

Rule

et al. 2019

Liver International

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More than 45% of US patients develop ALF caused by acetaminophen intoxication and have a transplant-free survival (TFS, spontaneous survival without transplantation) greater than 70%, rarely requiring transplantation. In stark contrast, patients with ALF not because of acetaminophen have a TFS less than 30% and frequently require transplantation. 3 Consequently, clinicians caring for patients with non-acetaminophen-induced ALF are most pressed to determine which patients require transplantation to survive. AbstractBackground: Changes in Gc-globulin (Gc) and in alpha-foetoprotein (AFP) have been shown to be related to outcome in patients with acute liver failure (ALF). Gc is a serum protein that complexes with intravascular actin released during cellular necrosis. AFP, also made by hepatocytes, is associated with hepatocellular growth and regeneration. Previously, low absolute levels or decreases over time in either AFP or Gc portended to be a poor outcome. Methods:In a retrospective analysis of the double-blind trial of intravenous N-acetylcysteine (NAC) for ALF not because of acetaminophen, sera on days 1 and 3 or days 2 and 4 following admission were available to measure AFP in 70 patients and Gc in 66 patients. Mann-Whitney U tests were performed on the admission values, the absolute change and the fractional change of AFP and Gc to compare TFS (transplant-free survival) and non-TFS (death or transplantation). Logistic regression and receiver operating characteristic (ROC) analyses were performed to evaluate the markers in comparison and in addition to King's College Criteria (KCC).Results: Transplant-free survival patients were characterized by increases in AFP, whereas non-TFS had significantly different (negative) absolute and fractional changes (P < .01). The addition of declining AFP levels to KCC improved the area under the curve in predicting non-TFS (AUC >70%). Gc globulin values did not differ between TFS and non-TFS in the 2-day intervals studied (P> .2). Conclusion:In this comparison of two prognostic markers in patients with non-acetaminophen-induced ALF, rising AFP but not rising Gc levels was associated with TFS.Trial Registration: ClinicalTrials.gov number NCT00004467. K E Y W O R D Sacute liver failure, AFP, Gc-globulin | 2369 SINGH et al.

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“…Studies have suggested that AFP could enhance the ability to predict the short-term survival of patients with LF, especially when it is between 76.0 and 252.2 ng/mL. [ 5 ]…”

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confidence: 99%

Comparison of clinical features and liver histology in liver failure caused by autoimmune hepatitis with different prognosis

Shi

Liu

et al. 2021

Chinese Medical Journal

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To the Editor: Autoimmune hepatitis (AIH) is a type of liver parenchymal inflammation mediated by the autoimmune response of liver cells. AIH was previously considered to be a chronic liver disease, but recent observers have confirmed that AIH patients can have acute onset or even liver failure (AIH-LF). [1] The incidence of AIH-LF has also increased. Once LF occurs, the mortality rate within 90 days could reach >40%. [2] Therefore, the occurrence of LF has a major impact on the prognosis of AIH. Although AIH-LF has a low incidence and a high mortality rate, some cases can still be cured by treatment. The clinical characteristics that may affect the prognosis of patients with AIH-LF are still unclear. To clarify the factors affecting the prognosis of AIH-LF, we compared the clinical characteristics of two groups of AIH-LF patients with different prognosis.

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Stratified alpha-fetoprotein pattern accurately predicts mortality in patients with acute-on-chronic hepatitis B liver failure

Abstract: Stratified AFP could strengthen the predictive power for short-term survival of patients with ACHBLF. Combining AFP quartiles with low serum sodium and high INR may better predict poor outcome in ACHBLF patients.

Cited by 6 publications

References 44 publications

A prognostic model for hepatitis B acute‐on‐chronic liver failure patients treated using a plasma exchange‐centered liver support system

A prognostic model for hepatitis B acute‐on‐chronic liver failure patients treated using a plasma exchange‐centered liver support system

Changes in alpha‐foetoprotein and Gc‐globulin in relation to outcomes in non‐acetaminophen acute liver failure

Comparison of clinical features and liver histology in liver failure caused by autoimmune hepatitis with different prognosis

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