scholarly journals Hepatitis B-related Acute-on-Chronic Liver Failure Induced by Hepatotropic Viral insult is Associated with Worse Prognosis Than that Induced by Non-Virus Insult

2021 ◽  
Author(s):  
Jing Liang ◽  
Lei Liu ◽  
Yingying Cao ◽  
Qian Zhang ◽  
Fang Liu ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Liver Failure ◽  
Time Frame ◽  
Chronic Liver ◽  
Hbv Reactivation ◽  
Virus Reactivation ◽  
Chronic Liver Failure ◽  
Significant Difference ◽  
Long Term Prognosis ◽  
Research Consortium

Abstract Objective: The manifestations and prognoses of acute-on-chronic liver failure (ACLF) with different precipitating events remain heterogeneous. We aimed to investigate the characteristics and prognosis of patients with hepatotropic viral insult (HVI)-induced hepatitis B-related ACLF (HBV-ACLF). Methods: 452 patients with confirmed diagnosis of ACLF were screened in three medical centers in China, and 203 HBV-ACLF patients with definite acute precipitating events were retrospectively analyzed. According to the precipitating events, HBV-ACLF patients induced by HBV reactivation and super-infection with HAV were classified as the hepatotropic viral insult group and those induced by other factors, as the non-virus insult (NVI) group. The clinical characteristics, predictive scoring model, and prognosis of the two groups were compared. Results: Hepatitis B virus reactivation accounted for the largest proportion (39.9%) among all precipitating events. Exacerbation time frame of the HVI group was significantly longer than that of the NVI group (20 days vs. 10 days, P<0.001). Comparison of intergroup prognosis showed that there was no significant difference in the 28-day mortality (20.9% vs. 13.7%, P=0.125), while the 90-day and 1-year mortality in the HVI group were higher than those in the NVI group (36.3% vs. 24.4%, P=0.014; 39.5% vs. 27.5%, P=0.020, respectively). In the HVI group, the lactic acid-free APASL-ACLF Research Consortium(AARC) had the highest predictive value for 90-day mortality (0.741). Conclusions: The 90-day and 1-year survival rate was lower in HBV-ACLF patients induced by HVI than by NVI. The lactate-free AARC score was a better predictor of short- and long-term prognosis in patients with HVI-induced HBV-ACLF.Trial registration: ChiCTR, ChiCTR1900021539 . Registered 26 February 2019 Retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=36342

scholarly journals Hepatitis B-related acute-on-chronic liver failure induced by hepatotropic viral insult is associated with worse prognosis than that induced by non-virus insult

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jing Liang ◽  
Lei Liu ◽  
Yingying Cao ◽  
Qian Zhang ◽  
Fang Liu ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Liver Failure ◽  
Time Frame ◽  
Chronic Liver ◽  
Hbv Reactivation ◽  
Virus Reactivation ◽  
Chronic Liver Failure ◽  
Significant Difference ◽  
Long Term Prognosis ◽  
Research Consortium

Abstract Background The manifestations and prognoses of acute-on-chronic liver failure (ACLF) with different precipitating events remain heterogeneous. We aimed to investigate the characteristics and prognosis of patients with hepatotropic viral insult (HVI)-induced hepatitis B-related ACLF (HBV-ACLF). Methods 452 patients with confirmed diagnosis of ACLF were screened in three medical centers in China, and 203 HBV-ACLF patients with definite acute precipitating events were retrospectively analyzed. According to the precipitating events, HBV-ACLF patients induced by HBV reactivation and super-infection with HAV were classified as the hepatotropic viral insult group and those induced by other factors, as the non-virus insult (NVI) group. The clinical characteristics, predictive scoring model, and prognosis of the two groups were compared. Results Hepatitis B virus reactivation accounted for the largest proportion (39.9%) among all precipitating events. Exacerbation time frame of the HVI group was significantly longer than that of the NVI group (20 days vs. 10 days, P < 0.001). Comparison of intergroup prognosis showed that there was no significant difference in the 28 day mortality (20.9 vs. 13.7%, P = 0.125), while the 90 day and 1 year mortality in the HVI group were higher than those in the NVI group (36.3 vs. 24.4%, P = 0.014; 39.5% vs. 27.5%, P = 0.020, respectively). In the HVI group, the lactic acid-free APASL-ACLF Research Consortium (AARC) had better predictive value for 90 day mortality (0.741). Conclusions The 90 day and 1 year survival rate was lower in HBV-ACLF patients induced by HVI than by NVI. The lactate-free AARC score was a better predictor of short- and long-term prognosis in patients with HVI-induced HBV-ACLF.

scholarly journals The Risk of Acute Kidney Injury in Hepatitis B Virus-Related Acute on Chronic Liver Failure with Tenofovir Treatment

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Kai Zhang ◽  
Su Lin ◽  
Mingfang Wang ◽  
Jiaofeng Huang ◽  
Yueyong Zhu
Keyword(s):  
Acute Kidney Injury ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Liver Failure ◽  
Antiviral Drug ◽  
Kidney Injury ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Significant Difference ◽  
B Virus

Aims. Tenofovir (TDF) is an antiviral drug with potential risk of kidney injury. The study is aimed at comparing the incidence of acute kidney injury (AKI) between TDF and entecavir (ETV) treatment in hepatitis B virus- (HBV-) related acute on chronic liver failure (ACLF). Methods. Treatment-naive patients with HBV-related ACLF were included. Propensity score matching was used to balance the baseline characteristics between ETV and TDF groups. The risk of AKI and the efficacy of TDF and ETV were compared. Results. A total of 95 cases with HBV-related ACLF were included in this study, with 74.74% of male and a mean age of 47.01±14.71 years. The antiviral therapy was initiated within 2 days after admission, with 39 cases on the TDF group and 56 on the ETV group. Patients in the TDF group had higher AST, hemoglobin, and serum sodium levels and lower MELD-Na score. After propensity matching, 39 cases of TDF and 39 of ETV were included in the final analysis. No difference was found in the changes of creatinine and cystatin C from baseline to 4 weeks after treatment between ETV and TDF groups. AKI was developed in 1 (2.56%) patient in the ETV group and 2 (5.13%) in the TDF group within one month (P=0.556). Survival analysis revealed no significant difference in the 6-month mortality between the two groups (P=0.813). Cox analysis showed that the type of antiviral drug or the development of AKI was not an independent risk factor for the outcomes. Conclusions. Compared to ETV, TDF did not increase the risk of AKI nor the mortality in patients with HBV-related ACLF in the short time.

scholarly journals Impact of compensated cirrhosis on survival in patients with acute-on-chronic liver failure

2021 ◽  
Author(s):  
Kessarin Thanapirom ◽  
Tongluk Teerasarntipan ◽  
Sombat Treeprasertsuk ◽  
Ashok Choudhury ◽  
Manoj K. Sahu ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Failure ◽  
Mortality Rates ◽  
Chronic Liver ◽  
Hbv Reactivation ◽  
Chronic Liver Failure ◽  
Alcoholic Fatty Liver ◽  
Compensated Cirrhosis ◽  
Research Consortium ◽  
Clinical Trials Registry

Abstract Background and aims Acute-on-chronic liver failure (ACLF) is considered a main prognostic event in patients with chronic liver disease (CLD). We analyzed the 28-day and 90-day mortality in ACLF patients with or without underlying cirrhosis enrolled in the ACLF Research Consortium (AARC) database. Methods A total of 1,621 patients were prospectively enrolled and 637 (39.3%) of these patients had cirrhosis. Baseline characteristics, complications and mortality were compared between patients with and without cirrhosis. Results Alcohol consumption was more common in cirrhosis than non-cirrhosis (66.4% vs. 44.2%, p < 0.0001), while non-alcoholic fatty liver disease/cryptogenic CLD (10.9% vs 5.8%, p < 0.0001) and chronic HBV reactivation (18.8% vs 11.8%, p < 0.0001) were more common in non-cirrhosis. Only 0.8% of patients underwent liver transplantation. Overall, 28-day and 90-day mortality rates were 39.3% and 49.9%, respectively. Patients with cirrhosis had a greater chance of survival compared to those without cirrhosis both at 28-day (HR = 0.48; 95% CI 0.36–0.63, p < 0.0001) and 90-day (HR = 0.56; 95% CI 0.43–0.72, p < 0.0001), respectively. In alcohol CLD, non-cirrhosis patients had a higher 28-day (49.9% vs. 23.6%, p < 0.001) and 90-day (58.4% vs. 35.2%, p < 0.001) mortality rate than cirrhosis patients. ACLF patients with cirrhosis had longer mean survival than non-cirrhosis patients (25.5 vs. 18.8 days at 28-day and 65.2 vs. 41.2 days at 90-day). Exaggerated systemic inflammation might be the reason why non-cirrhosis patients had a poorer prognosis than those with cirrhosis after ACLF had occurred. Conclusions The 28-day and 90-day mortality rates of ACLF patients without cirrhosis were significantly higher than those with cirrhosis in alcoholic CLD. The presence of cirrhosis and its stage should be evaluated at baseline to guide for management. Thai Clinical Trials Registry, TCTR20191226002.

HINT: a novel prognostic model for patients with hepatitis B virus-related acute-on-chronic liver failure

2018 ◽  
Vol 48 (7) ◽  
pp. 750-760 ◽  
Author(s):  
Daxian Wu ◽  
Zeyu Sun ◽  
Xiaoli Liu ◽  
Qunfang Rao ◽  
Wenqian Chen ◽  
...  
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Liver Failure ◽  
Prognostic Model ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
B Virus
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