Value of Liver Regeneration in Predicting Short-Term Prognosis for Patients with Hepatitis B-Related Acute-on-Chronic Liver Failure

Background and Aims. The value of hepatocyte regeneration in predicting the outcomes of hepatitis B-related acute-on-chronic liver failure (HBV-ACLF) is not fully assessed. The present study was aimed at establishing a novel scoring system to predict patients’ outcomes within 3 months by applying serological indicators of hepatic regeneration and liver injury. Methods. Patients with chronic hepatitis B who had a rapid deterioration were investigated. Patients were observed for 90 days, and the endpoint of follow-up was death or liver transplantation. Serum parameters were estimated on the diagnosis of acute-on-chronic liver failure (ACLF). Cox proportional hazard regression was used to identify independent prognostic factors and create a novel prognostic scoring system, and a receiver operating characteristic (ROC) curve was used to analyze the performance of the model. Results. A total of 308 patients with HBV-ACLF were incorporated and divided into the training cohort (n=206) and testing cohort (n=102) randomly. Creatine (Cre), age, total bilirubin (TBil), alpha-fetoprotein (AFP), and international normalized ratio (INR) were found to be independent prognostic factors. According to the results of Cox regression analysis, a new prognostic model (we named it the TACIA score) was calculated. The areas under ROC (AUROC) for the new model were 0.861 and 0.763 in the training and testing cohorts, respectively, and patients with lower TACIA scores (<4.34) would survive longer (P<0.001). Conclusions. A pertinent prognostic scoring system for patients with HBV-ACLF was established in our study, and the novel model could predict patients’ short-term survival effectively.

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Interferon-α2b improves short-term survival in patients transplanted for chronic liver failure caused by hepatitis B

Journal of Viral Hepatitis ◽

10.1111/j.1365-2893.1996.tb00107.x ◽

1996 ◽

Vol 3 (6) ◽

pp. 333-340 ◽

Cited By ~ 7

Author(s):

T. Hassanein ◽

A. Colantoni ◽

N. De Maria ◽

D.H. Van Thiel

Keyword(s):

Hepatitis B ◽

Liver Failure ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Short Term ◽

Term Survival ◽

Interferon Α2b ◽

Short Term Survival

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Prognostic factors of the short-term outcomes of patients with hepatitis B virus-associated acute-on-chronic liver failure

Clinics ◽

10.6061/clinics/2017(11)07 ◽

2017 ◽

Vol 72 (11) ◽

pp. 686-692 ◽

Cited By ~ 5

Author(s):

Q Lei ◽

K Ao ◽

Y Zhang ◽

D Ma ◽

D Ding ◽

...

Keyword(s):

Prognostic Factors ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Liver Failure ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Short Term ◽

B Virus

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Increased IL-17-producing CD8+ T cell frequency predicts short-term mortality in patients with hepatitis B virus-related acute-on-chronic liver failure

Therapeutics and Clinical Risk Management ◽

10.2147/tcrm.s184809 ◽

2018 ◽

Vol Volume 14 ◽

pp. 2127-2136 ◽

Cited By ~ 5

Author(s):

Geng-lin Zhang ◽

Ting Zhang ◽

Qi-yi Zhao ◽

Chan Xie ◽

Chao-shuang Lin ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Liver Failure ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Short Term ◽

Cell Frequency ◽

B Virus ◽

Short Term Mortality

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Serum Clusterin: A Potential Marker for Assessing the Clinical Severity and Short-Term Prognosis of Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Disease Markers ◽

10.1155/2020/8814841 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11

Author(s):

Huimin Liu ◽

Yuxin Li ◽

Fangyuan Gao ◽

Peipei Meng ◽

Hao Yu ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Liver Failure ◽

Chronic Liver ◽

Clinical Severity ◽

Chronic Liver Failure ◽

Short Term ◽

Potential Biomarker ◽

B Virus ◽

Normal Controls

Background. Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by acute deterioration of liver function and high short-term mortality. Clusterin, with biological functions similar to small heat shock proteins, can protect cells from apoptosis induced by various stressors. The aim of this study was to detect the level of serum clusterin in hepatitis B virus- (HBV-) related ACLF and to assess the predictive value of clusterin for the short-term prognosis of HBV-ACLF. Methods. We detected serum clusterin by ELISA in 108 HBV-ACLF patients, 63 HBV-non-ACLF patients, and 44 normal controls. Results. Serum clusterin was markedly lower in HBV-ACLF patients (median, 51.09 μg/mL) than in HBV-non-ACLF patients (median, 188.56 μg/mL) and normal controls (median, 213.45 μg/mL; all P < 0.05 ). Nonsurviving HBV-ACLF patients who died within 90 days had much lower clusterin levels than did surviving patients, especially those who died within 28 days (nonsurvival group vs. survival group: 39.82 ± 19.34 vs. 72.26 ± 43.52 , P < 0.001 ; survival time ≤ 28 vs. survival time > 28 : median 28.39 vs. 43.22, P = 0.013 ). The results showed that for identifying HBV-ACLF, the sensitivity of clusterin (93.7%) was similar to the sensitivities of the international normalized ratio (INR; 94.4%) and total bilirubin (TBIL; 94.8%), but its specificity (90.7%) was higher than that of prothrombin activity (PTA; 65.8%) and TBIL (69.8%) and was similar to INR (88.9%). As the concentration of clusterin increased, the mortality of HBV-ACLF patients decreased significantly from 59.3% to 7.0%. Clusterin had better ability for predicting the prognosis of HBV-ACLF patients than did the model for end-stage liver disease (MELD) score and the chronic liver failure consortium (CLIF-C) ACLF score (MELD vs. clusterin: P = 0.012 ; CLIF-C ACLF vs. clusterin: P = 0.031 ). Conclusion. Serum clusterin is a potential biomarker for HBV-ACLF which can be used to assess clinical severity and the short-term prognosis of patients with this disease and may help clinicians identify HBV-ACLF with greater specificity and improved prognostic accuracy than existing prognostic markers.

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Predictive value of the Chinese group on the study of severe hepatitis B-acute-on-chronic liver failure score in the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

Chinese Medical Journal ◽

10.1097/cm9.0000000000000298 ◽

2019 ◽

Vol 132 (13) ◽

pp. 1541-1549

Author(s):

Jing-Jing Tong ◽

Wei Zhao ◽

Xiu-Ying Mu ◽

Xiang Xu ◽

Hai-Bin Su ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Liver Failure ◽

Predictive Value ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Short Term ◽

Severe Hepatitis ◽

B Virus ◽

Chinese Group

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Fecal Microbiota Transplantation in Alcohol-Associated Acute on Chronic Liver Failure: An Open-label Clinical Trial

10.21203/rs.3.rs-408638/v1 ◽

2021 ◽

Author(s):

Anima Sharma ◽

Akash Roy ◽

Madhumita Premkumar ◽

Ajay Duseja ◽

Sunil Taneja ◽

...

Keyword(s):

Liver Failure ◽

Fecal Microbiota Transplantation ◽

Fecal Microbiota ◽

Chronic Liver ◽

Clinical Severity ◽

Chronic Liver Failure ◽

Short Term ◽

Open Label ◽

Term Survival ◽

Severity Scores

Abstract Background: Severe alcoholic hepatitis (SAH) presenting as acute-on-chronic liver failure (ACLF) carries a high short-term mortality. Alteration of gut microbiota is a crucial component implicated in its pathogenesis, whose modulation has been suggested as a potential therapeutic tool. We evaluated the safety of fecal microbiota transplantation (FMT) and its efficacy in improving short-term survival and clinical severity scores in patients with SAH-ACLF.Methods: Thirty-three patients [13 in the FMT arm;20 in the standard of care arm (SOC] with SAH-ACLF were included in this open-label study. A single FMT session was administered as a freshly prepared stool suspension from pre-identified healthy family member stool donors through a nasojejunal tube. Patients were followed up on days seven, twenty-eight, and ninety. Results: Survival at twenty-eight and ninety days was significantly better in the FMT arm (100% versus 60%, P=0.01; 53.84% versus 25%, P=0.02). Hepatic encephalopathy resolved in 100% versus 57.14% (FMT versus SOC, P=0.11) patients, while ascites resolved in 100% versus 40% survivors (P=0.04). Major adverse event rates, including spontaneous bacterial peritonitis and gastrointestinal bleeding, were similar in both groups (P=0.77; P=0.70). Median IL1beta decreased by21.39% (IQR -73.67-7.63) in the FMT group, whereas it increased in the SOC by 27.44% (IQR -0.88-128.11) (P=0.01). Percentage changes in bilirubin and ALT between baseline and day seven emerged as predictors of ninety-day mortality.Conclusion: FMT is safe, improves short-term and medium-term survival, and leads to improvement in clinical severity scores in patients with SAH-ACLF.

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The scoring systems in predicting short-term outcomes in patients with hepatitis B virus-related acute-on-chronic liver failure

Annals of Palliative Medicine ◽

10.21037/apm-20-608 ◽

2020 ◽

Vol 9 (5) ◽

pp. 3048-3058 ◽

Cited By ~ 1

Author(s):

Hui Li ◽

Jun Zheng ◽

Liang Chen ◽

Jianye Cai ◽

Min Zhang ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Liver Failure ◽

Scoring Systems ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Short Term ◽

B Virus

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Copeptin in acute decompensation of liver cirrhosis: relationship with acute-on-chronic liver failure and short-term survival

Critical Care ◽

10.1186/s13054-017-1894-8 ◽

2017 ◽

Vol 21 (1) ◽

Cited By ~ 7

Author(s):

Annarein J. C. Kerbert ◽

◽

Hein W. Verspaget ◽

Àlex Amorós Navarro ◽

Rajiv Jalan ◽

...

Keyword(s):

Liver Cirrhosis ◽

Liver Failure ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Short Term ◽

Term Survival ◽

Acute Decompensation ◽

Short Term Survival

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Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure

Gut ◽

10.1136/gutjnl-2017-314641 ◽

2017 ◽

Vol 67 (12) ◽

pp. 2181-2191 ◽

Cited By ~ 46

Author(s):

Tianzhou Wu ◽

Jiang Li ◽

Li Shao ◽

Jiaojiao Xin ◽

Longyan Jiang ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Liver Failure ◽

Diagnostic Criteria ◽

Prognostic Score ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Short Term ◽

Hospitalised Patients ◽

B Virus

ObjectiveThe definition of acute-on-chronic liver failure (ACLF) based on cirrhosis, irrespective of aetiology, remains controversial. This study aimed to clarify the clinicopathological characteristics of patients with hepatitis B virus-related ACLF (HBV-ACLF) in a prospective study and develop new diagnostic criteria and a prognostic score for such patients.DesignThe clinical data from 1322 hospitalised patients with acute decompensation of cirrhosis or severe liver injury due to chronic hepatitis B (CHB) at 13 liver centres in China were used to develop new diagnostic and prognostic criteria.ResultsOf the patients assessed using the Chronic Liver Failure Consortium criteria with the exception of cirrhosis, 391 patients with ACLF were identified: 92 with non-cirrhotic HBV-ACLF, 271 with cirrhotic HBV-ACLF and 28 with ACLF with cirrhosis caused by non-HBV aetiologies (non-HBV-ACLF). The short-term (28/90 days) mortality of the patients with HBV-ACLF were significantly higher than those of the patients with non-HBV-ACLF. Total bilirubin (TB) ≥12 mg/dL and an international normalised ratio (INR) ≥1.5 was proposed as an additional diagnostic indicator of HBV-ACLF, and 19.3% of patients with an HBV aetiology were additionally diagnosed with ACLF. The new prognostic score (0.741×INR+0.523×HBV-SOFA+0.026×age+0.003×TB) for short-term mortality was superior to five other scores based on both discovery and external validation studies.ConclusionsRegardless of the presence of cirrhosis, patients with CHB, TB ≥12 mg/dL and INR ≥1.5 should be diagnosed with ACLF. The new criteria diagnosed nearly 20% more patients with an HBV aetiology with ACLF, thus increasing their opportunity to receive timely intensive management.

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