Complications constitute a major risk factor for mortality in hepatitis B virus-related acute-on-chronic liver failure patients: a multi-national study from the Asia-Pacific region
单位：[1]Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan 430030, People’s Republic of China华中科技大学同济医学院附属同济医院[2]Departments of Hepatology and Transplant, Institute of Liver and Biliary Sciences, New Delhi 110070, India[3]Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh[4]State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China浙江大学医学院附属第一医院[5]Youan Hospital, Capital Medical University, Beijing, China[6]Department of Hepatology, Selayang Hospital, Batu Caves, Malaysia[7]Department of Gastroenterology, Third Central Hospital, Tianjing, China[8]Liver Failure Treatment and Research Center, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China[9]Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan[10]National University of Singapore and National University Hospital, Singapore, Singapore[11]Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia[12]Department of Hepatology, Hebei Medical University, Shijiazhuang, China[13]Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India[14]Department of Medicine, Queen Mary Hospital, Hong Kong, China[15]Department of Gastroenterology and Hepatology, St John Medical College, Bangalore, India[16]Department of Hepatology, KEM Hospital, Mumbai, India[17]Department of Hepatogastroenterology, Ziauddin University, Karachi, Pakistan[18]Department of Gastroenterology and Hepatology, IMS and SUM Hospital, Odisa, India[19]Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey[20]Medistra Hospital, Digestive Disease and GI Oncology Center, Jakarta, Indonesia[21]Liver Research Center, Beijing Friendship Hospital, Beijing, China临床科室国家中心肝病分中心首都医科大学附属北京友谊医院[22]Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
Background and Aim Cirrhosis is a controversial determinant of mortality in HBV-related acute-on-chronic liver failure (HBV-ACLF). The present study aimed to explore the effects of cirrhosis and the associated risk factors, especially its complications, on the outcome of HBV-ACLF. Methods A prospective-retrospective cohort of 985 patients was identified from the APASL-ACLF Research Consortium (AARC) database and the Chinese Study Group. Complications of ACLF (ascites, infection, hepatorenal syndrome, hepatic encephalopathy, upper gastrointestinal bleeding) as well as cirrhosis and the current main prognostic models were measured for their predictive ability for 28- or 90-day mortality. Results A total of 709 patients with HBV-ACLF as defined by the AARC criteria were enrolled. Among these HBV-ACLF patients, the cirrhotic group showed significantly higher mortality and complications than the non-cirrhotic group. A total of 36.1% and 40.1% of patients met the European Association for the Study of Liver (EASL)-Chronic Liver Failure consortium (CLIF-C) criteria in the non-cirrhotic and cirrhotic groups, respectively; these patients had significantly higher rates of mortality and complications than those who did not satisfy the CLIF-C criteria. Furthermore, among patients who did not meet the CLIF-C criteria, the cirrhotic group exhibited higher mortality and complication rates than the non-cirrhotic group, without significant differences in organ failure. The Tongji prognostic predictor model score (TPPMs), which set the number of complications as one of the determinants, showed comparable or superior ability to the Chinese Group on the Study of Severe Hepatitis B-ACLF score (COSSH-ACLFs), APASL-ACLF Research Consortium score (AARC-ACLFs), CLIF-C organ failure score (CLIF-C OFs), CLIF-C-ACLF score (CLIF-C-ACLFs), Model for End-Stage Liver Disease score (MELDs) and MELD-sodium score (MELD-Nas) in HBV-ACLF patients, especially in cirrhotic HBV--ACLF patients. Patients with two (OR 4.70, 1.88) or three (OR 8.27, 2.65) complications had a significantly higher risk of 28- or 90-day mortality, respectively. Conclusion The presence of complications is a major risk factor for mortality in HBV-ACLF patients. TPPM possesses high predictive ability in HBV-ACLF patients, especially in cirrhotic HBV-ACLF patients.
基金：
National Thirteenth "Five Years" Project in Science and Technology of China [2017ZX10202201, 2018ZX10302-206]
第一作者单位：[1]Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan 430030, People’s Republic of China
通讯作者：
推荐引用方式(GB/T 7714)：
Tao Chen,Zhongyuan Yang,Ashok Kumar Choudhury,et al.Complications constitute a major risk factor for mortality in hepatitis B virus-related acute-on-chronic liver failure patients: a multi-national study from the Asia-Pacific region[J].HEPATOLOGY INTERNATIONAL.2019,13(6):695-705.doi:10.1007/s12072-019-09992-x.
APA：
Tao Chen,Zhongyuan Yang,Ashok Kumar Choudhury,Mamun Al Mahtab,Jun Li...&Qin Ning.(2019).Complications constitute a major risk factor for mortality in hepatitis B virus-related acute-on-chronic liver failure patients: a multi-national study from the Asia-Pacific region.HEPATOLOGY INTERNATIONAL,13,(6)
MLA：
Tao Chen,et al."Complications constitute a major risk factor for mortality in hepatitis B virus-related acute-on-chronic liver failure patients: a multi-national study from the Asia-Pacific region".HEPATOLOGY INTERNATIONAL 13..6(2019):695-705
医学