Submassive hepatic necrosis distinguishes HBV-associated acute on chronic liver failure from cirrhotic patients with acute decompensation

Li, Hai; Xia, Qiang; Zeng, Bing; Li, Shu-Ting; Liu, Heng; Li, Qi; Li, Jun; Yang, Shao; Dong, Xiaorong; Gao, Ting; Munker, Stefan; Liu, Yan; Liebe, Roman; Xue, Feng; Li, Qigen; Chen, Xiaosong; Liu, Qiang; Zeng, Hui; Wang, Jiyao; Xie, Qing; Meng, Qin-Hua; Wang, Jiefei; Mertens, Peter R.; Lammert, Frank; Singer, Manfred V.; Dooley, Steven; Ebert, Matthias; Qiu, Dekai; Wang, Tailing; Weng, Honglei

doi:10.1016/j.jhep.2015.01.029

Cited by 82 publications

(67 citation statements)

References 24 publications

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“…Marked regeneration may be present in some patients with a short disease course, but absent in others with a long clinical history. Similar phenomena are also observed in patients with ACLF (Li et al, 2015). …”

Section: Pathological Characteristics Of Mhnsupporting

confidence: 80%

“…In a recent clinical study, we investigated 174 transplanted livers with HBV-related cirrhosis (Li et al, 2015). Among them, 69 had severe necrosis between 15–90% of the entire liver.…”

Section: Pathological Characteristics Of Mhnmentioning

confidence: 99%

“…As mentioned above, we organized a prospective single-center study recently, in which 174 patients undergoing liver transplantation due to acute decompensation of hepatitis B virus (HBV)-associated liver cirrhosis were investigated (Li et al, 2015). In this study, MHN and SMHN were defined as necrosis of more than 90% and 15–90% of the entire liver on explant, respectively (Hanau et al, 1995).…”

Section: Massive Necrosis In Acute-on-chronic Liver Failurementioning

confidence: 99%

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Two sides of one coin: massive hepatic necrosis and progenitor cell-mediated regeneration in acute liver failure

et al. 2015

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Massive hepatic necrosis is a key event underlying acute liver failure, a serious clinical syndrome with high mortality. Massive hepatic necrosis in acute liver failure has unique pathophysiological characteristics including extremely rapid parenchymal cell death and removal. On the other hand, massive necrosis rapidly induces the activation of liver progenitor cells, the so-called “second pathway of liver regeneration.” The final clinical outcome of acute liver failure depends on whether liver progenitor cell-mediated regeneration can efficiently restore parenchymal mass and function within a short time. This review summarizes the current knowledge regarding massive hepatic necrosis and liver progenitor cell-mediated regeneration in patients with acute liver failure, the two sides of one coin.

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Section: Pathological Characteristics Of Mhnsupporting

confidence: 80%

“…In a recent clinical study, we investigated 174 transplanted livers with HBV-related cirrhosis (Li et al, 2015). Among them, 69 had severe necrosis between 15–90% of the entire liver.…”

Section: Pathological Characteristics Of Mhnmentioning

confidence: 99%

Section: Massive Necrosis In Acute-on-chronic Liver Failurementioning

confidence: 99%

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Two sides of one coin: massive hepatic necrosis and progenitor cell-mediated regeneration in acute liver failure

et al. 2015

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“…Some scholars have reported that the pathological changes associated with ACLF may be diverse and dominated by massive or sub-massive necrosis; cirrhosis accompanied with hepatitis may be one expression [11,12]. Li et al [13] found that sub-massive hepatic necrosis is a pathological feature of hepatitis B virus (HBV)-associated ACLF.…”

Section: The Pathology and Clinical Significance Of Liver Failurementioning

confidence: 99%

Clinical Classification of Liver Failure: Consensus, Contradictions and New Recommendations

Xing¹

2017

J Clin Gastroenterol Hepatol

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Liver failure (LF) is a clinical syndrome with complex clinical manifestations. The clinical diagnosis and classification of LF are still considerably different internationally. Based on the pace of the disease progression and its possible reversibility, LF can be divided into two categories: acute and chronic LF. However, a great difference exists in the diagnostic criteria between China, Europe, and the United States. These differences might be related to the various causes of LF, the complexity of clinical manifestations, and different experiences of experts from different centers. The main source of differences lies in the varied understanding of LF diagnostic standards.The pathologic basis of various types of LF is different also. This article discusses the clinical diagnosis and classification of LF internationally and suggests new recommendations for classification of LF. According to this classification, ALF is divided into fulminant type and subacute type, and CLF is divided into acute exacerbative type and slowly progressive type. This classification, if adopted worldwide, could help achieve uniformity in the classification and therapeutic guidelines for liver failure. However, the validity of the classification should be further tested in clinical practice.

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“…Acute-on-chronic liver failure (ACLF) is a clinical entity that is characterized by an acute deterioration of preexisting chronic liver disease, with a high 28-day mortality [1, 2]. In China, the hepatitis B virus (HBV)-related ACLF constitutes more than 90% of all ACLF cases and is the major cause of HBV infection-related mortality [3].…”

Section: Introductionmentioning

confidence: 99%

Persistently Increased Resting Energy Expenditure Predicts Short-Term Mortality in Patients with Acute-on-Chronic Liver Failure

et al. 2018

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Objective: Hypermetabolism based on measurements of resting energy expenditure (REE) is suggested to be a potential biomarker for predicting the clinical outcomes of some diseases. We aimed to evaluate the potential value of hypermetabolism for predicting the short-term (28-day) mortality of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods: A total of 105 HBV-ACLF patients, 30 chronic hepatitis B (CHB) patients and 30 healthy controls (HCs) were included in this study. The REE was measured using indirect calorimetry in the morning after 8–10 h of fasting. The predicted REE (REEHB) was determined using Harris-Benedict equation. Persistent hypermetabolism was defined as the REE:REEHB ratio > 1.20 at day 1 and day 7 after admission. The severity of liver disease was estimated using the Model for End-Stage Liver Disease (MELD). Clinical and biochemical variables were determined using blood samples ordered upon admission. These variables were compared between nonsurviving and surviving patients who were classified according to the 28-day mortality. Results: The frequency of hypermetabolism at baseline was significantly higher in ACLF patients than that in HCs and CHB patients. Forty-six (43.8%) ACLF patients died within follow-up of 28 days. Persistent hypermetabolism (OR 2.10; 95% CI 1.15–3.69; p = 0.002) and MELD score (OR 1.93; 95% CI 1.47–3.51; p = 0.012) were independent predictive indicators of 28-day mortality. Furthermore, the performance of the 2 variables (persistent hypermetabolism and MELD) together with the area under the receiver operating curve (AUROC: 0.819) was significantly better than that of MELD alone (AUROC: 0.694) for prediction of short-term mortality (p = 0.014). Conclusion: These findings indicate that persistent hypermetabolism is predictive of short-term mortality in this small population.

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Submassive hepatic necrosis distinguishes HBV-associated acute on chronic liver failure from cirrhotic patients with acute decompensation

Cited by 82 publications

References 24 publications

Two sides of one coin: massive hepatic necrosis and progenitor cell-mediated regeneration in acute liver failure

Two sides of one coin: massive hepatic necrosis and progenitor cell-mediated regeneration in acute liver failure

Clinical Classification of Liver Failure: Consensus, Contradictions and New Recommendations

Persistently Increased Resting Energy Expenditure Predicts Short-Term Mortality in Patients with Acute-on-Chronic Liver Failure

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