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

Abstract Background Acute-on-chronic liver failure (ACLF) is a widely recognized concept in which acute decompensation (AD) in patients with cirrhosis results in organ failures and high short-term mortality. However, few studies reflecting the various etiologies of cirrhosis are available. We aimed to investigate the clinical features of patients with hepatitis C virus (HCV)-related ACLF. Methods Between January 2005 and December 2018, 109 HCV-related cirrhosis patients who were hospitalized for AD (ascites, hepatic encephalopathy, gastrointestinal hemorrhage, and/or bacterial infection) were enrolled for ACLF defined by European Association for the Study of the Liver (EASL). Results ACLF developed in 35 patients (32.1%) on admission. Eight patients had ACLF grade 1, eight had ACLF grade 2, and 19 had ACLF grade 3. The 28-day and 90-day mortality rates were very low (2.7% and 5.4%, respectively) in patients without ACLF and very high (60.0% and 74.3%, respectively) in those with ACLF. In patients with HCV-related ACLF, the prevalence of liver failure was very low (17.1%), whereas that of kidney failure was very high (71.4%) compared to previous studies on hepatitis B virus-related ACLF and alcohol-related ACLF. Compared with all other prognostic scores, Chronic liver failure Consortium Organ Failure score most accurately predicted 90-day mortality, with an area under the receiver operator characteristic of 0.921. Conclusions HCV-related ACLF has unique clinical characteristics that are distinct from hepatitis B virus-related and alcohol-related ACLF. ACLF defined by EASL can be useful in predicting short-term mortality in HCV-related cirrhosis.

Download Full-text

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.

Download Full-text

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

Download Full-text

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

Download Full-text

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.

Download Full-text