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

BMC Infectious Diseases

Tao Han¹  Qian Zhang²  Jing Liang²  Fang Liu²  Jun Li²  Lei Liu²  Hua Liu²  Yingying Cao²  Zhongping Duan³  Manman Xu³  Yu Chen³  Fangjiao Song⁴  Shaojie Xin⁴  Shaoli You⁴ 

[1] Department of Hepatology, The Third Central Clinical College of Tianjin Medical University, 83, Jintang Road, 300170, Tianjin, China;Department of Hepatology and Gastroenterology, Tianjin Union Medical Center Affiliated to Nankai University, 190, Jieyuan Road, Hongqiao District, Tianjin, China;Department of Hepatology, The Third Central Clinical College of Tianjin Medical University, 83, Jintang Road, 300170, Tianjin, China;Department of Hepatology, The Third Central Hospital of Tianjin, Tianjin, China;Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China;Artificial Cell Engineering Technology Research Center, Tianjin, China;Tianjin Institute of Hepatobiliary Disease, Tianjin, China;Fourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You’an Hospital Affiliated to Capital Medical University, Beijing, China;Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China;The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China;

关键词: Acute-on-chronic liver failure;    Hepatitis B virus reactivation;    Precipitating events;    Prognosis;   

DOI  :  10.1186/s12879-021-06974-z

来源: Springer

【 摘 要 】

BackgroundThe 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).Methods452 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.ResultsHepatitis 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).ConclusionsThe 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.

【 授权许可】

CC BY