Different Effects of Total Bilirubin on 90-Day Mortality in Hospitalized Patients With Cirrhosis and Advanced Fibrosis: A Quantitative Analysis

Frontiers in Medicine

article

Liang Qiao¹  Feng Liu³  Xiaobo Lu⁵  Jia Shang⁶  Junping Liu⁶  Huadong Yan⁷  Wenyi Gu¹  Yan Zhang¹  Xiaomei Xiang⁸  Yixin Hou⁹  Qun Zhang⁹  Wenting Tan⁸  Yan Xiong^1,10  Congcong Zou^1,10  Jun Chen^1,11  Zebing Huang^1,11  Xiuhua Jiang^1,12  Sen Luo^1,13  Yuanyuan Chen^1,13  Na Gao^1,14  Chunyan Liu^1,14  Wei Yuan^1,15  Xiaobo Wang⁹  Xue Mei^1,15  Jing Li⁴  Tao Li⁴  Rongjiong Zheng⁵  Xinyi Zhou⁵  Jinjun Chen^1,12  Guohong Deng⁸  Weituo Zhang^1,16  Hai Li¹  Xin Zheng^1,10  Yan Huang^1,11  Beiling Li^1,12  Zhongji Meng^1,13  Yanhang Gao^1,14  Zhiping Qian^1,15 

[1] Department of Gastroenterology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University;Key Laboratory of Gastroenterology and Hepatology, Shanghai Institute of Digestive Disease, Chinese Ministry of Health, Shanghai Jiao Tong University;Tianjin Institute of Hepatology, Nankai University Second People's Hospital;Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University;Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University;Department of Infectious Diseases, Henan Provincial People's Hospital;Department of Infectious Diseases, Hwamei Hospital, Ningbo No. 2 Hospital, University of Chinese Academy of Sciences;Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University);Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University;Department of Infectious Diseases, Tongji Medical College, Institute of Infection and Immunology, Union Hospital, Huazhong University of Science and Technology;Hunan Key Laboratory of Viral Hepatitis, Department of Infectious Diseases, Xiangya Hospital, Central South University;Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University;Department of Infectious Disease, Taihe Hospital, Hubei University of Medicine;Department of Hepatology, The First Hospital of Jilin University;Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University;Clinical Research Center, Shanghai Jiao Tong University School of Medicine

关键词: liver failure;    cutoff;    quantitative analyse;    short-term mortality;    total bilirubin;   

DOI  :  10.3389/fmed.2021.704452

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Introduction: Total bilirubin (TB) is a major prognosis predictor representing liver failure in patients with acute on chronic liver failure (ACLF). However, the cutoff value of TB for liver failure and whether the same cutoff could be applied in both cirrhotic and non-cirrhotic patients remain controversial. There is a need to obtain the quantitative correlation between TB and short-term mortality via evidence-based methods, which is critical in establishing solid ACLF diagnostic criteria. Methods: Patients hospitalized with cirrhosis or advanced fibrosis (FIB-4 > 1.45) were studied. TB and other variables were measured at baseline. The primary outcome was 90-day transplantation-free mortality. Multi-variable Cox proportional hazard model was used to present the independent risk of mortality due to TB. Generalized additive model and second derivate (acceleration) were used to plot the “TB-mortality correlation curves.” The mathematical (maximum acceleration) and clinical (adjusted 28-day transplantation-free mortality rate reaching 15%) TB cutoffs for liver failure were both calculated. Results: Among the 3,532 included patients, the number of patients with cirrhosis and advanced fibrosis were 2,592 and 940, respectively, of which cumulative 90-day mortality were 16.6% (430/2592) and 7.4% (70/940), respectively. Any increase of TB was found the independent risk factor of mortality in cirrhotic patients, while only TB >12 mg/dL independently increased the risk of mortality in patients with advanced fibrosis. In cirrhotic patients, the mathematical TB cutoff for liver failure is 14.2 mg/dL, with 23.3% (605/2592) patients exceeding it, corresponding to 13.3 and 25.0% adjusted 28- and 90-day mortality rate, respectively. The clinical TB cutoff for is 18.1 mg/dL, with 18.2% (471/2592) patients exceeding it. In patients with advanced fibrosis, the mathematical TB cutoff is 12.1 mg/dL, 33.1% (311/940) patients exceeding it, corresponding to 2.9 and 8.0% adjusted 28- and 90-day mortality rate, respectively; the clinical TB cutoff was 36.0 mg/dL, 1.3% (12/940) patients above it. Conclusion: This study clearly demonstrated the significantly different impact of TB on 90-day mortality in patients with cirrhosis and advanced fibrosis, proving that liver failure can be determined by TB alone in cirrhosis but not in advanced fibrosis. The proposed TB cutoffs for liver failure provides solid support for the establishment of ACLF diagnostic criteria.

【 授权许可】

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