External validation and comparison of six prognostic models in a prospective cohort of HBV-ACLF in China

Background. Acute-on-chronic liver failure has high mortality. Currently, robust models for predicting the outcome of hepatitis B virus (HBV)-associated ACLF are lacking.Aim. To assess and compare the performance of six prevalent models for short- and longterm prognosis in patients with HBV-ACLF.Material and methods. The model for end-stage liver disease (MELD), MELD sodium (MELD-Na), MELD to sodium ratio (MESO), integrated MELD, Child-Turcotte-Pugh (CTP), and modified CTP (mCTP) were validated in a prospective cohort of 232 HBV-ACLF patients. The six models were evaluated by determining discrimination, calibration and overall performance at 3 months and 5 years.Results. According to the Hosmer-Lemeshow tests and calibration plots, all models could adequately describe the data except CTP at 3 months. Discrimination analysis showed that the iMELD score had the highest AUC of 0.76 with sensitivity of 62.6% and specificity of 80.2% for an optimal cut-off value of 52 at 3 months. It also had the highest AUC of 0.80 with sensitivity of 89.9% and specificity of 48.2% for an optimal cut-off value of 43 at 5 years. The overall performance of iMELD, assessed with Nagelkerke’s R² and the Brier score, was also the best among the six models.Conclusion. Integrated MELD may be the best model to predict short- and long-term prognosis in patients with HBV-ACLF.     

Usefulness of serum thyroid-stimulation hormone (TSH) as a prognostic indicator for acute-on-chronic liver failure

Background and rationale for the study. To investigate thyroid function in patients with acute-on-chronic liver failure (ACLF) caused by hepatitis B virus infection and to determine whether thyroid hormone levels can be used as prognostic markers for assessing severity and prognosis of ACLF patients. We enrolled 75 patients with ACLF and70 patients with chronic hepatitis B (CHB).Continual serum samples were collected during hospitalization from the ACLF patients. The serum thyroid hormone levels (triiodothyronine [T3], thyroxine [T4], free (F)-T3, FT4, and thyroid stimulation hormone [TSH]) were measured by chemiluminescence. The Model for End-stage Liver Disease (MELD) score was used to assess severity.Results. ACLF patients showed significantly (p < 0.001) lower values of serum T3, T4, FT3/FT4 and TSH than CHB patients. The T3, T4, and TSH levels in ACLF patients were negatively correlated with the MELD score (T3: r = -0.495, p < 0.001; T4: r = -0.281, p < 0.001; TSH: r = -0.498, p < 0.001), suggesting that serum thyroid hormone levels reflect disease severity. At 1 year, 31 patients died. The T3 (p = 0.016), T4 (p = 0.008), and TSH (p = 0.003) levels in non-survivors were significantly lower than in survivors. The serum TSH level was a significant factor for predicting mortality in ACLF patients (optimal cutoff value = 0.38 IU/mL). The cumulative survival rate was decreased significantly when the serum TSH level was < 0.38 IU/mL (39.2%, p < 0.001).Conclusion. Serum TSH level may be a useful indicator for assessing severity and prognosis in ACLF patients.     

血清IL-8水平预测HBV相关慢加急性肝衰竭患者短期预后的临床研究

目的探讨血清IL-8水平用于评价HBV相关慢加急性肝衰竭(HBV related acute-on-chronic liver failure,HBVACLF)患者短期预后的临床价值。方法纳入2016年1月—2018年8月我院收住的HBV-ACLF患者110例,根据住院60 d内是否病死分为生存组(n=64)及病死组(n=46)。收集患者入院时临床资料并计算终末期肝病模型(model of endstage liver disease,MELD)评分,检测血清IL-8水平,使用ROC曲线分析血清IL-8水平用于评价患者短期预后的价值。结果病死组患者血清IL-8水平及MELD评分均显著高于生存组,差异有统计学意义(P均<0.05)。预测HBV-ACLF患者60 d病死情况时,IL-8的AUC为0.817,MELD评分的AUC为0.811,IL-8联合MELD评分预测60 d病死情况的AUC为0.841。入院时高IL-8水平(≥349.7 pg/ml)患者60 d总体生存率著低于低IL-8水平(<349.7 pg/ml)患者(36.4%vs.80.0%,Log-rank P<0.001)。结论血清IL-8水平作为评价HBV-ACLF患者短期预后指标具有较好的临床价值。     

Different models in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

Background and aims. Effective assessing the prognosis of patients with end-stage liver disease is always challenging. This study aimed to investigate the accuracy of different models in predicting short-term prognosis of patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF).Material and methods. We retrospectively evaluated survival of a cohort of patients with at least 3-month follow up. The receiver-operating-characteristic curves (ROC) were drawn for Child-Turcotte-Pugh (CTP) classification, King’s College Hospital (KCH) criteria, model for end-stage liver disease (MELD), MELD combined with serum sodium (Na) concentration (MELDNa), integrated MELD (iMELD) and logistic regression model (LRM).Results. Of the 273 eligible patients, 152 patients (55.7%) died within 3-month follow up. In cirrhotic patients (n = 101), the AUCs of LRM (0.851), MELDNa (0.849), iMELD (0.845) and MELD (0.840) were all significantly higher than those of KCH criteria (0.642) and CTP (0.625) (all p < 0.05), while the differences among LRM, MELD, MELDNa and iMELD were not significant, and the most predictive cutoff value was 0.5176 for LRM, 30 for MELDNa, 47.87 for iMELD and 29 for MELD, respectively. In non-cirrhotic patients (n = 172), the AUC of LRM (0.897) was significantly higher than that of MELDNa (0.776), iMELD (0.768), MELD (0.758), KCH criteria (0.647) and CTP (0.629), respectively (all p < 0.05), and the most predictive cutoff value for LRM was-0.3264.Conclusions. LRM, MELD, MELDNa and iMELD are with similar accuracy in predicting the short-term prognosis of HBV-ACLF patients with liver cirrhosis, while LRM is superior to MELD, MELDNa and iMELD in predicting the short-term prognosis of HBV-ACLF patients without liver cirrhosis.     

Serum soluble ST2 is a promising prognostic biomarker in HBV-related acute-on-chronic liver failure

BACKGROUND: The IL-33/ST2 axis is involved in the patho-genesis of many diseases such as autoimmune diseases, cancer, and heart failure. However, studies of the IL-33/ST2 pathway in HBV-related acute-on-chronic liver failure (HBV-ACLF) are lacking. The present study aimed to determine the prognostic role of serum IL-33/soluble ST2 (sST2) in HBV-ACLF.METHODS: Serum levels of IL-33 and sST2 in healthy controls (HC, n=18), chronic hepatitis B (CHB, n=27) and HBV-ACLF (n=51) patients at the 1st and 4th week after enrollment were detected using ELISA, and clinical data were collected. The follow-up of HBV-ACLF patients lasted for 6 months at least.RESULTS: There was no significant difference of serum IL-33 level among HC, CHB and HBV-ACLF patients at week 1. However, serum sST2 level differed significantly among the three groups: highest in the HBV-ACLF group, moderate in the CHB group and lowest in the HC group. There was a re-verse correlation between serum sST2 level and the survival of HBV-ACLF patients. The level of serum sST2 in HBV-ACLF survivors was significantly declined from week 1 to week 4 following the treatment, whereas that in HBV-ACLF non-survivors remained at a high level during the same period. Fur-thermore, serum sST2 level was significantly correlated with laboratory parameters and the most updated prognostic scores (CLIF-C OF score, CLIF-C ACLF score and ACLF grades). The receiver operating characteristics curves demonstrated that serum sST2 level was a good diagnostic marker for predicting the 6-month mortality in HBV-ACLF patients, comparable to the most updated prognostic scores. Serum sST2 cut-off points for predicting prognosis in HBV-ACLF patients were 76 ng/mL at week 1 or 53 ng/mL at week 4, respectively. HBV-ACLF pa-tients with serum sST2 level above the cut-off point often had a worse prognosis than those below the cut-off point.CONCLUSION: Serum sST2 may act as a promising biomark-er to assess severity and predict prognosis of patients with HBV-ACLF and help for the early identification and optimal treatment of HBV-ACLF patients at high risk of mortality.     

Hyperkalemia influences the outcome of patients with cirrhosis with acute decompensation (AD) and acute-on-chronic liver failure (ACLF)

IntroductionThe presence of hyperkalemia in different clinical scenarios has been described as a risk factor for mortality. Information about this electrolyte disorder in patients with cirrhosis is limited and there are no data in patients with acute-on-chronic liver failure (ACLF).AimThe aim of this study was to investigate whether hyperkalemia is a risk factor for mortality in patients with cirrhosis and acute decompensation (AD) with and without ACLF.MethodsWe performed an analysis of the Chronic Liver Failure Consortium CANONIC database in 1,314 consecutive patients admitted to 29 European centers with AD both with and without associated ACLF (294 and 1020 respectively). Hyperkalemia was defined as serum potassium ≥ 5.0 mEq/L. All patients had at least one valid measure of serum potassium from admission and/or through the whole hospitalization.Results1314 patients were admitted with AD and 294 of them had ACLF at admission. Prevalence of hyperkalemia was significantly higher in ACLF versus AD (22.4% and 8.6% respectively, p<0.001). Hyperkalemia was associated with an increased 90, 180 and 360-day mortality risk in ACLF compared to AD (HR 10 vs 2.3 at 90-day p<0.001, 8.9 vs 3.1 at 180-day, p<0.001 and 5.8 vs 3.8 at 360-day, p<0.001). In a multivariate analysis, the presence of hyperkalemia during admission was independently associated with 90-day mortality [HR 2.4 (1.7 – 3.4)]. Variability of potassium between two valid measures ≥ 0.9 mg/dl was always also associated with a higher mortality rate. Addition of hyperkalemia to MELD score (MELD-K model) improved the accuracy to predict 90-day mortality risk.ConclusionsHyperkalemia is an independent risk factor of mortality in patients with AD and ACLF. Addition of hyperkalemia to the MELD score improves diagnostic accuracy to predict 90-day mortality in patients with AD and ACLF.     

Comparison of Dynamic Changes Among Various Prognostic Scores in Viral Hepatitis-Related Acute Liver Failure

Introduction and aim. Multiple prognostic scores are available for acute liver failure (ALF). Our objective was to compare the dynamicity of model for end stage liver disease (MELD), MELD-sodium, acute liver failure early dynamic model (ALFED), chronic liver failure (CLIF)-consortium ACLF score and King’s College Hospital Criteria (KCH) for predicting outcome in ALF.Materials and methods. All consecutive patients with ALF at a tertiary care centre in India were included. MELD, MELD-Na, ALFED, CLIF-C ACLF scores and KCH criteria were calculated at admission and day 3 of admission. Area under receiver operator characteristic curves (AUROC) were compared with DeLong method. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) and diagnostic accuracy (DA) were reported.Results. Of the 115 patients included in the study, 73 (63.5%) died. The discrimination of mortality with baseline values of prognostic scores (MELD, MELD-Na, ALFED, CLIF-C ACLF and KCH) was modest (AUROC: 0.65-0.77). The AUROC increased on day 3 for all scores, except KCH criteria. On day 3 of admission, ALFED score had the highest AUROC 0.95, followed by CLIF-C ACLF 0.88, MELD 0.81, MELD-Na 0.77 and KCH 0.52. The AUROC for ALFED was significantly higher than MELD, MELD-Na and KCH (P < 0.001 for all) and CLIF-C ACLF (P = 0.05). ALFED score > 4 on day 3 had the best sensitivity (87.1%), specificity (89.5%), PPV (93.8%), NPV (79.1%), LR positive (8.3) and DA (87.9%) for predicting mortality.Conclusions. Dynamic assessment of prognostic scores better predicts outcome. ALFED model performs better than MELD, MELD, MELD-Na, CLIF-C ACLF scores and KCH criteria for predicting outcome in viral hepatitis-related ALF.     

HBV相关慢加急性肝衰竭患者短期预后的影响因素分析

目的分析探究影响HBV相关慢加急性肝衰竭(HBV-ACLF)短期预后的危险因素。方法收集2009年1月—2019年12月西安交通大学第二附属医院收治的240例非肝移植HBV-ACLF患者的临床资料,按照入院后28 d和90 d存活情况进行分组(28 d:生存组164例,死亡组76例;90 d:生存组140例,死亡组100例)。收集患者发病诱因、肝功能指标、MELD评分、MELD-Na评分和出现的并发症等资料。计量资料用2组间比较采用Mann-Whithey U检验,计数资料2组间比较采用χ^2检验。根据ROC曲线,计算ROC曲线下面积(AUC),采用约登指数确定临界值,HBV-ACLF短期预后的危险因素分析采用logistic多因素回归分析。结果HBV-ACLF患者的诱因主要包括HBV自发激活(55.6%)、核苷类似物停药或耐药引起HBV激活(25.2%)等。依28 d存活情况分组,基线资料中年龄、PTA、NLR、血钠、MELD评分、MELD-Na评分、TBil水平2组间比较差异均有统计学意义(Z值分别为-2.400、-6.015、-5.070、-5.103、-5.044、-7.430、-6.637,P值均<0.05);依90 d生存情况分组,基线资料中年龄、PTA、NLR、血钠、MELD评分、MELD-Na评分、TBil、胆固醇水平2组间比较差异均有统计学意义(Z值分别为-2.205、-7.728、-3.335、-4.015、-6.053、-7.908、-6.655、-3.607,P值均<0.05)。logistic多因素回归分析显示,TBil>260.20 mmol/L、PTA<24.8%、NLR>5.63、血钠<130.8 mmol/L、MELD>17.84分、MELD-Na>25.1分是影响患者28 d生存的独立危险因素[OR(95%CI)分别为4.572(1.321~15.823)、8.934(3.026~26.374)、2.632(1.126~6.152)、27.467(6.113~123.423)、4.303(1.048~17.663)、3.453(1.614~7.387),P值均<0.05];TBil>260.20 mmol/L、PTA<25.5%、血钠<135.3 mmol/L、MELD>17.84分、MELD-Na>25.1分是影响患者90 d生存的独立危险因素[OR(95%CI)分别为5.148(1.918~13.822)、15.718(5.161~47.866)、10.080(3.244~31.323)、11.157(2.580~48.254)、4.391(2.057~9.372),P值均<0.05]。240例患者中160例(66.7%)90 d内发生感染,其中细菌感染140例、病毒感染12例,真菌感染8例。160例出现感染的患者其90 d病死率显著高于无感染的患者(46.3%vs 32.5%,χ^2=6.720,P=0.010)。240例患者中176例28 d内出现腹水,44例出现胸腔积液,36例发生急性肾损伤,60例发生肝性脑病,12例发生消化道出血,2组间急性肾损伤、Ⅲ~Ⅳ度肝性脑病、消化道出血所占比例比较差异均有统计学意义(χ^2值分别为64.088、29.811、7.797,P值均<0.05)。结论HBV-ACLF患者基线TBil、PTA、血钠、MELD评分、MELD-Na评分是影响患者28 d和90 d预后的独立危险因素。HBV激活引起的肝脏炎症坏死是ACLF的始动因素,而感染、急性肾损伤、肝性脑病和消化道出血是影响患者预后的主要的并发症。     

MELD评分联合血清降钙素原评估乙型肝炎相关慢加急性肝衰竭患者短期预后的价值

目的探讨MELD评分联合血清降钙素原(PCT)预测乙型肝炎慢加急性肝衰竭(ACLF)患者短期预后的临床价值。方法选取2012年1月至2015年12月于云南省第三人民医院住院的乙型肝炎相关ACLF患者331例,分为生存组(208例)和死亡组(123例),比较两组患者的血清TBil、肌酐(Cr)、国际标准化比值(INR)、血清钠(Na~+)、MELD评分和血清PCT。计量资料两组间比较采用独立样本Mann-Whitney U检验或t检验,计数资料组间比较采用χ~2检验,受试者工作特征曲线下面积(AUC)比较采用正态Z检验。结果死亡组患者的TBil(330.9±81.9)μmol/L比(245.5±67.7)μmol/L、Cr(94.9±23.8)μmol/L比(71.2±29.3)μmol/L、INR(2.5±1.0)μmol/L比(2.1±0.6)μmol/L、MELD评分(26.2±6.5)比(22.0±5.8)、血清PCT浓度(1.3±0.3)μg/L比(0.5±0.2)μg/L均高于生存组,血清Na~+水平(128.9±14.1)mmol/L比(133.8±9.3)mmol/L低于生存组,差异均有统计学意义(均P0.01)。MELD评分、血清PCT预测乙型肝炎相关ACLF患者近期死亡危险性的最佳临界值分别为24.8、0.65μg/L。MELD评分联合血清PCT判断乙型肝炎相关ACLF短期预后的AUC为0.880,高于单独MELD评分的AUC0.820和PCT的AUC0.803,差异均有统计学意义(均P0.01)。结论 MELD评分联合血清PCT对乙型肝炎相关ACLF患者短期预后的预测价值良好。     

动态MELD评分有助于预测HBV相关慢加急性肝衰竭预后

目的探讨在判断HBV相关慢加急性肝衰竭(HBV-related acute-on-chronic liver failure,HBV-ACLF)患者预后方面,终末期肝病模型(model for end-stage liver disease,MELD)评分的动态变化是否优于基线MELD评分。方法前瞻性收集2009—2011年在我国4家医院住院治疗的HBV-ACLF患者的临床资料,包括临床表现、实验室检查及转归等,研究MELD评分动态变化与转归的关系。结果①纳入的82例90 d病死率为37.80%。死亡组患者基线MELD评分为(25.50±4.77)分,与存活组[(23.72±4.68)分]相比,差异无统计学意义(P=0.101)。但是从入组第7天开始,死亡组MELD评分逐渐升高,存活组MELD评分逐渐下降,此后各时间点2组MELD评分相比差异均有统计学意义。②低危组(基线MELD评分≤23分者)从第14天开始,存活患者MELD评分显著低于死亡患者[(16.04±4.00)分vs(29.39±12.30)分,P<0.05],高危组(基线MELD评分>23分者)从第7天开始,存活患者MELD评分显著低于死亡患者[(22.38±4.91)分vs(28.92±6.76)分,P=0.001],并且随着时间推移,差距逐渐增加。结论判断HBV-ACLF的预后应在基线MELD评分基础上,注意其动态变化,这将有助于提高预测的准确性。     

IL-32联合终末期肝病模型对HBV相关慢加急性肝衰竭患者预后的预测价值

目的探讨IL-32联合终末期肝病模型(MELD)对HBV相关慢加急性肝衰竭(HBV-ACLF)患者预后的预测价值。方法选取2015年1月-2018年12月在苏州大学附属第一医院住院的92例HBV-ACLF患者,根据确诊后3个月随访情况分为存活组(n=40)和死亡组(n=52)。采用酶联免疫吸附试验(ELISA)测定患者的血清IL-32水平。收集患者的临床资料,包括年龄、性别、合并基础疾病、主要并发症、WBC、PLT、红细胞比积(HCT)、TBil、ALT、AST、Alb、SCr、PT、INR、HBV DNA等。符合正态分布的计量资料2组间比较采用t检验,不符合正态分布的计量资料2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ2检验;IL-32与其他变量进行Pearson相关性分析;采用二元logistic回归分析影响HBV-ACLF患者预后的独立危险因素;利用ROC曲线下面积(AUC)评价IL-32联合MELD评分对HBV-ACLF预后的预测价值,AUC的比较采用正态性Z检验。结果2组间HCT、PLT、TBil、SCr、PT、INR、HBV DNA、IL-32、MELD评分比较差异均有统计学意义(P值均<0.05);IL-32与TBil(r=0.952,P<0.001)、MELD评分(r=0.850,P<0.001)均呈显著正相关;IL-32(OR=1.137,95%CI:1.040~1.243,P=0.005)和MELD评分(OR=1.055,95%CI:1.001~1.109,P=0.025)是HBV-ACLF患者死亡的独立危险因素;IL-32联合MELD评分对HBV-ACLF患者预后的预测价值最高(AUC=0.992,95%CI:0.981~1.000),优于IL-32(AUC=0.984)和MELD评分(AUC=0.877),差异均具有统计学意义(Z值分别为2.265、3.182,P值均<0.05)。结论IL-32、MELD评分均能预测HBV-ACLF患者预后,两者联合则预测价值更高。     

CTP-MELD评分联合血清M30和M65预测乙型肝炎相关慢加急性肝衰竭短期预后的价值

目的探讨肝功能评分(CTP)-终末期肝病模型(MELD)联合血清M30和M65对乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者短期预后的预测价值。方法选择2017年1月至2020年1月南京市第二医院接受治疗的HBV-ACLF患者106例,根据90 d预后分为生存组51例与死亡组55例。比较两组患者一般情况、实验室指标、血清M30和M65水平,受试者特征曲线分析下面积CTP-MELD评分联合血清M30和M65与HBV-ACLF短期预后的关系。结果死亡组患者的CTP、MELD评分分别为(23.02±5.18)分和(31.18±5.89)分,高于存活组的(10.49±1.05)分和(13.21±1.34)分(t=16.949、21.276,均P<0.01);死亡组的血清M30、M65水平分别为(1685.12±413.32)U/L和(2799.41±712.05)U/L,均高于存活组的(1001.40±316.49)U/L和(1808.85±669.43)U/L(t=9.507、8.608,均P<0.01)。CTP、MELD、M30、M65单独预测90 d病死的AUC分别为0.624(95%CI:0.525~0.716)、0.804(95%CI:0.716~0.875)、0.750(95%CI:0.656~0.829)、0.887(95%CI:0.810~0.940),4项联合的AUC为0.919(95%CI:0.850~0.963),明显优于CTP、MELD、M30单项评价(P<0.05),高于M65单项评价但差异无统计学意义(P>0.05)。结论CTP、MELD评分和血清M30、M65能够较好地预测HBV-ACLF患者短期预后,且4项联合检测具有更高的预测价值。     

Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis

AIM To evaluate the differences in acute kidney injury(AKI) between acute-on-chronic liver failure(ACLF) and decompensated cirrhosis(DC) patients. METHODS During the period from December 2015 to July 2017, 280 patients with hepatitis B virus(HBV)-related ACLF(HBV-ACLF) and 132 patients with HBV-related DC(HBV-DC) who were admitted to our center were recruited consecutively into an observational study. Urine specimens were collected from all subjects and the levels of five urinary tubular injury biomarkers were detected,including neutrophil gelatinase-associated lipocalin(NGAL), interleukin-18(IL-18), liver-type fatty acid binding protein(L-FABP), cystatin C(CysC), and kidney injury molecule-1(KIM-1). Simultaneously, the patient demographics, occurrence and progression of AKI, and response to terlipressin therapy were recorded. All patients were followed up for 3 mo or until death after enrollment. RESULTS AKI occurred in 71 and 28 of HBV-ACLF and HBV-DC patients, respectively(25.4% vs 21.2%, P = 0.358). Among all patients, the levels of four urinary biomarkers(NGAL, CysC, L-FABP, IL-18) were significantly elevated in patients with HBV-ACLF and AKI(ACLF-AKI), compared with that in patients with HBV-DC and AKI(DC-AKI) or those without AKI. There was a higher proportion of patients with AKI progression in ACLF-AKI patients than in DC-AKI patients(49.3% vs 17.9%, P = 0.013). Fortythree patients with ACLF-AKI and 19 patients with DC-AKI were treated with terlipressin. The response rate of ACLFAKI patients was significantly lower than that of patients with DC-AKI(32.6% vs 57.9%, P = 0.018). Furthermore, patients with ACLF-AKI had the lowest 90 d survival rates among all groups(P 0.001).CONCLUSION AKI in ACLF patients is more likely associated with structural kidney injury, and is more progressive, with a poorer response to terlipressin treatment and a worse prognosis than that in DC patients.     

Metabolic Risk Factors Are Associated with the Disease Severity and Prognosis of Hepatitis B Virus-Related Acute on Chronic Liver Failure

Background/AimsMetabolic risk factors could accelerate hepatitis B virus (HBV)-related mortality; however, their impacts on disease severity in HBV-related acute on chronic liver failure (HBV-ACLF) patients remain unexplored. In this study, we assessed the effects of metabolic risk factors on the outcome of HBV-ACLF patients.MethodsThis study retrospectively enrolled antiviral therapy naïve HBV-ACLF patients from a single center in China. Patients were evaluated according to Child-Turcotte-Pugh score, Model for End-Stage Liver Disease (MELD) score, 30-day, 90-day mortality and survival rate to estimate the prognosis of HBV-ACLF. The impacts of different metabolic risk factors were further analyzed.ResultsA total of 233 patients, including 158 (67.8%) with metabolic risk factors and 75 (32.2%) without metabolic risk factors, were finally analyzed. Patients with metabolic risk factors had significantly higher MELD score (22.6±6.1 vs 19.8±3.8, p<0.001), 90-day mortality rate (56.3% vs 38.7%, p=0.017), and shorter median survival time (58 days vs 75 days hazard ratio, 1.553; 95% confidence interval, 1.061 to 2.274; p=0.036) than patients without them. Moreover, metabolic risk factors were independently associated with patients’ 90-day mortality (hazard ratio, 1.621; 95% confidence interval, 1.016 to 2.585; p=0.043). Prediabetes/diabetes and hypertension were related to higher rates of infection and worse renal function in HBV-ACLF patients.ConclusionsHBV-ACLF patients with metabolic risk factors, especially prediabetes/diabetes or hypertension, could have more severe disease and lower survival rates. In addition, the existence of metabolic disorder is an independent risk factor for HBV-ACLF patients’ 90-day mortality.     

Comparison of the prognostic value of Chronic Liver Failure Consortium scores and traditional models for predicting mortality in patients with cirrhosis

Background and aim

Recently, the European Association for the Study of the Liver – Chronic Liver Failure (CLIF) Consortium defined two new prognostic scores, according to the presence or absence of acute-on-chronic liver failure (ACLF): the CLIF Consortium ACLF score (CLIF-C ACLFs) and the CLIF-C Acute Decompensation score (CLIF-C ADs). We sought to compare their accuracy in predicting 30- and 90-day mortality with some of the existing models: Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD), MELD-Na, integrated MELD (iMELD), MELD to serum sodium ratio index (MESO), Refit MELD and Refit MELD-Na.

NLR联合血清IL-6水平预测慢加急性乙型肝炎肝衰竭患者近期预后的价值探讨

目的 研究应用中性粒细胞/淋巴细胞比值(NLR)联合血清白细胞介素6(IL-6)水平预测慢加急性乙型肝炎肝衰竭(HBV-ACLF)患者近期预后的价值。方法 2019年9月～2021年9月我院诊治的HBV-ACLF患者72例,给予综合内科治疗,观察28 d生存率。常规检测血常规,计算NLR,采用ELISA法测定血清IL-6水平,应用Logistic回归分析影响近期预后的因素,应用受试者工作特征(ROC)曲线评估NLR联合血清IL-6水平预测近期预后的效能。结果 72例HBV-ACLF患者28 d生存53例,死亡19例(26.4%);死亡患者NLR为(7.2±2.2),血清IL-6水平为(13.6±3.5)pg/ml,显著高于生存患者【分别为(3.7±1.0)和(8.7±1.5)pg/ml,P<0.05】,死亡组年龄、肝性脑病发生率和MELD评分显著高于生存组,而PLT计数显著低于生存组(P<0.05);经Logistic回归分析发现,年龄、肝性脑病、MELD评分、NLR和血清IL-6水平均为影响近期预后的独立因素(P<0.05);经ROC分析显示,分别以NLR>4...     

Model for end-stage liver disease underestimates mortality of patients with acute-on-chronic liver failure waiting for liver transplantation

Background and AimsPatients with acute-on-chronic liver failure (ACLF) show excess mortality in MELD-Na based organ allocation for liver transplantation (LT). Whether MELD-based allocation in the Eurotransplant region similarly underprioritizes ACLF patients is unknown.Methods428 patients listed for LT from 01/2010 to 02/2021 at a tertiary center in Germany were screened and 209 patients included as derivation (n = 123) and validation cohort (n = 86). Competing risk analysis for waitlist mortality and LT as competing events was performed.Results90-day waitlist mortality for patients with MELD < and ≥ 25 at baseline was 9% vs. 33%, respectively (p = 0.009). Competing risk analysis shows significantly higher 90-day waitlist mortality in patients listed with ACLF compared to those without ACLF (p = 0.021) in the low MELD stratum. Probability of LT was similar between the two groups (p = 0.91). In the high MELD group, 90-day waitlist mortality and rates of LT were not significantly different between patients with and without ACLF (31% vs. 20%, p = 0.55 and 59% vs. 60%, p = 0.72, respectively). Post-transplant survival was similar between patients with and without ACLF. This result was confirmed in the validation cohort.ConclusionMELD-based organ allocation in the Eurotransplant region underestimates waitlist mortality in patients with ACLF in lower MELD ranges.     

Artificial liver support systems for hepatitis B virus-associated acute-on-chronic liver failure: A meta-analysis of the clinical literature

To evaluate the short-term and long-term survival efficacy of an artificial liver support system (ALSS) in patients with acute-on-chronic liver failure (ACLF). A systematic search was performed for relevant published data in PubMed, Web of Science and Cochrane Library databases. Studies that evaluated the efficacy of ALSS in patients with ACLF and provided the short-term or long-term survival rate were included. A total of 10 studies involving 3685 patients were included in this analysis. The pooled 28-day survival rate and 90-day survival rate were 68.7% (95% CI: 64.5%–72.9%) and 53.4% (95% CI: 45.5%–61.4%), respectively. The pooled estimates of the OR for the 28-day and 90-day survival rates between the ALSS group and the control group were 1.91 (95% CI: 1.21–3.04) and 1.41 (95% CI: 1.17–1.70), respectively. Subgroup analysis showed that patients treated with lower levels of TBIL and MELD scores had a higher 28-day survival rate (χ² = 15.75, p < 0.01; χ² = 13.80, p < 0.01). The present meta-analysis suggests that ALSS treatment could remarkably improve short-term survival rates in HBV-ACLF patients, which implies that treatment with ALSS may help to reduce high mortality. Further prospective randomized trials are needed to validate these findings.     

Quantification of circulating miR-125b-5p predicts survival in chronic hepatitis B patients with acute-on-chronic liver failure

Aims

To analyze the role of serum miR-125b-5p in reflecting liver damage and predicting outcomes in chronic hepatitis B (CHB) patients with acute-on-chronic liver failure (ACLF).