Improving the survival rate of acute-on-chronic liver failure patients complicated with invasive pulmonary aspergillosis

Background.Currently, both of entecavir and lamivudine are effective for patients with HBV-associated acute-on-chronic liver failure (ACLF). However, there is no consensus on the efficacy of entecavir versus lamivudine for patients with HBV-associated ACLF. The aim of the study was to compare the efficacy and safety of entecavir with that of lamivudine for HBV-associated ACLF patients.Methods.Publications on entecavir versus lamivudine in HBV-associated ACLF patients were comprehensively identified. Odds ratio and mean difference were used to measure the effect.Results.Ten studies, totaling 1254 patients, were eligible. No significant differences between the two drugs presented in the 1-, 2-, 3-, or 6-month survival rates. However, after 12 months of treatment, patients prescribed entecavir had a statistically higher survival rate (p=0.008) and lower total bilirubin (p<0.0001) and alanine aminotransferase (p=0.04) levels compared to patients prescribed lamivudine. More patients achieved HBV negative levels when taking entecavir as measured at 1-, 3-, and 12-month time points and had a lower rate of HBV recurrence.Conclusion.While entecavir and lamivudine are both relatively safe and well tolerated, entecavir was more efficacious in terms of survival rate and clinical improvement in long-term treatment. Further prospective randomized controlled trials are needed to validate these results.

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HBV Associated Cirrhotic Patients Meeting Apasl Acute-On-Chronic Liver Failure Criteria Have Heterogeneous Outcome and Short Term Survival Rate

Journal of Hepatology ◽

10.1016/s0168-8278(16)00316-0 ◽

2016 ◽

Vol 64 (2) ◽

pp. S271-S272

Author(s):

H. Li ◽

L.-Y. Chen ◽

Q. Xie ◽

N.-N. Zhang ◽

S. Yin ◽

...

Keyword(s):

Survival Rate ◽

Liver Failure ◽

Failure Criteria ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Short Term ◽

Term Survival ◽

Cirrhotic Patients ◽

Short Term Survival

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Relationship Between Platelet to White Blood Cell Ratio and 30-Day Prognosis of Patients with Acute-on-Chronic Liver Failure

Hepatitis Monthly ◽

10.5812/hepatmon.118640 ◽

2021 ◽

Vol 21 (9) ◽

Author(s):

Xiang Xu ◽

Chen Li ◽

Jing Chen ◽

Xiaoyan Liu ◽

Haibin Su ◽

...

Keyword(s):

Survival Rate ◽

Blood Cell ◽

Liver Failure ◽

White Blood Cell ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Cox Models ◽

Factors Affecting ◽

Cell Ratio ◽

The Relationship

Background: Acute-on-chronic liver failure (ACLF) is always associated with thrombocytopenia or leukocytosis. Therefor the platelet to white blood cell ratio (PWR) in ACLF patients is always reduced. Objectives: Here, we assessed the relationship between PWR and prognosis in ACLF patients. Methods: A retrospective cohort of 415 patients, including 100 patients that were diagnosed of chronic hepatitis B, 104 patients suffered of HBV-related liver cirrhosis and 211 patients suffered of HBV-related ACLF, was investigated. Univariate and multivariate COX models were used to investigate the relationship between PWR and 30-day survival in patients with ACLF. Factors affecting PWR in ACLF patients were also analysed using logistic regression analysis. Results: At baseline, the platelet count in patients with HBV-related ACLF was significantly lower than that in patients with CHB and patients suffered of HBV-related cirrhosis. The PWR value was much higher in the survivors of ACLF than in ACLF patients who died. PWR, age, total bilirubine, prothrombin activity, and aspartate transaminase were independent predictors of the 30-day survival rate of ACLF patients. We also found that ascites and infection were independent factors related to the decrease of PWR in ACLF patients. Conclusions: The PWR value was significant declined in ACLF patients. And it was independent risk factors for the survival rate of those patients.

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Epidemiology of invasive pulmonary aspergillosis in patients with liver failure: Clinical presentation, risk factors, and outcomes

Journal of International Medical Research ◽

10.1177/0300060517729907 ◽

2017 ◽

Vol 46 (2) ◽

pp. 819-827 ◽

Cited By ~ 2

Author(s):

Xuan Zhang ◽

Meifang Yang ◽

Jianhua Hu ◽

Hong Zhao ◽

Lanjuan Li

Keyword(s):

Risk Factors ◽

Liver Failure ◽

Hepatorenal Syndrome ◽

Clinical Presentation ◽

Invasive Pulmonary Aspergillosis ◽

Antibiotic Use ◽

Chronic Liver Failure ◽

Pulmonary Aspergillosis ◽

Independent Risk Factors ◽

Male Sex

Objective Invasive pulmonary aspergillosis (IPA) is a severe and often lethal infection. The possible risk factors, clinical presentation, and treatment of patients with simultaneous liver failure and IPA have received little attention in previous studies. The aim of this study was to investigate the epidemiology of IPA in patients with liver failure in an effort to reduce patient mortality. Methods The patients with liver failure (including acute liver failure , sub-acute liver failure , acute-on-chronic liver failure and chronic liver failure) were recruited from 2011 to 2016. The clinical data of these patients were retrieved for the study. Results In total, 1077 patients with liver failure were included in this study. Of the 1077 patients, 53 (4.9%) had IPA. Forty-four (83%) patients with IPA died. Independent risk factors for IPA were male sex (hazard ratio [HR] = 2.542), hepatorenal syndrome (HR = 2.463), antibiotic use (HR = 4.631), and steroid exposure (HR = 18.615). Conclusions IPA is a fatal complication in patients with liver failure. Male sex, hepatorenal syndrome, antibiotic use, and steroid exposure were independent risk factors for IPA. When patients with liver failure have these risk factors and symptoms of pneumonia such as cough or hemoptysis, clinicians should be cautious about the possibility of IPA.

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