medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2018, Number 3

<< Back Next >>

Ann Hepatol 2018; 17 (3)

A Dynamic Model for Predicting Outcome in Patients with HBV Related Acute-On-Chronic Liver Failure

Lin W, Zhang J, Liu X, Liu H, He J, Li M, Zhang S, Zhang Y, Chen H, Zhang C, Wu W, Jin C, Lee SS, Duan Z

Language: English
References: 35
Page: 392-402
PDF size: 186.22 Kb.


ABSTRACT

Introduction and aim. Accurately predicting the prognosis of individual patient is crucial in the management of ACLF. We aimed to establish a specific prognostic model for HBV-related ACLF patients treated with nucleoside analog (NA). Material and methods. We prospectively collected 205 ACLF cases diagnosed according to the APASL criteria. A dynamic prognostic model based on APASL criteria was established and validated. To demonstrate that the model is also applicable to those within EASL criteria, we divided the patients into two groups: met APASL criteria only (group A, n = 123); met both APASL and EASL criteria (group B, n = 82). Its prognostic accuracy was also compared with chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score in group B. Results. The model is: R = 0.94 x Bilirubin + 0.53 x evolution of Bilirubin - 0.45 x PT-A - 0.22 x evolution in PT-A -0.1 x PLT + 10 x anti-HBe. The area under receiver operating characteristic curve (AUC) of the model for predicting 90-day mortality was 0.86, which was significantly higher than that of model for end stage liver disease(MELD), MELD-Na, CLIF-SOFA, ΔMELD (7d) and ΔMELD-Na (7d), ΔCLIF- SOFA(7d) (all p ‹ 0.01). The AUC of our model in the validation group was 0.79 which was superior to MELD (0.45) CLIF-SOFA (0.53) score in group B patients (p ‹ 0.01). Conclusion. In conclusion, the model was superior to the conventional methods in predicting the outcomes of patients with HBV related ACLF treated with NA. It is the first description of a novel prognostic model using consecutive data in patients with HBV-induced acute-on-chronic liver failure (ACLF) treated by nucleoside analogs.


REFERENCES

  1. Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, Durand F, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144: 1426-37.

  2. Sarin SK, Kumar A, Almeida JA, Chawla YK, Fan ST, Garg H, de Silva HJ, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int 2009; 3: 269-82.

  3. Galbois A, Das V, Carbonell N, Guidet B. Prognostic scores for cirrhotic patients admitted to an intensive care unit: which consequences for liver transplantation? Clin Res Hepatol Gastroenterol 2013; 37: 455-66.

  4. Wan Z, Wu Y, Yi J, You S, Liu H, Sun Z, Zhu B, et al.Combining serum cystatin C with total bilirubin improves short-term mortality prediction in patients with HBV-related acute-on-chronic liver failure. PLoS One 2015; 28: e0116968.

  5. Xie F, Yan L, Lu J, Zheng T, Shi C, Ying J, Shen R, et al. Effects of nucleoside analogue on patients with chronic hepatitis B-associated liver failure: meta- analysis. PloS one 2013; 8: e54773.

  6. Zhang L, Hao CQ, Liu JF, Wang M. Meta-analysis of the short-term effects of lamivudine treatment for severe chronic hepatitis B. Virol J 2013; 10: 134.

  7. Zhang L, Hao CQ, Liu JF, Wang M. The efficacy and safety of nucleos(t)ide analogues in the treatment of HBV-related acute-on-chronic liver failure: a meta -analysis. Ann Hepatol 2013; 12: 364-72.

  8. Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F, Angeli P, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology 2003; 38: 258-66.

  9. Runyon BA; AASLD.Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology 2013; 57: 1651-3.

  10. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy- Definition, nomenclature, diagnosis, and quantification: Final report of the Working Party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 2002; 35: 716-21.

  11. Ganem D, Prince AM. Hepatitis B virus infection--natural history and clinical consequences. N Engl J Med 2004; 350: 1118-29.

  12. Kanno A, Suzuki H, Miyazaki Y, Sato S, Otsuki M, Goto Y, Ohori H. Severe acute exacerbation in chronic hepatitis B virus infection in Sendai, Japan. Tohoku J Exp Med 1988; 155: 363-71.

  13. Chen CH, Lin CL, Hu TH, Hung CH, Tseng PL, Wang JH, Chang JY, et al. Entecavir vs. lamivudine in chronic hepatitis B patients with severe acute exacerbation and hepatic decompensation. J Hepatol 2014; 60: 1127-34.

  14. Garg H, Sarin SK, Kumar M, Garg V, Sharma BC, Kumar A. Tenofovir improves the outcome in patients with spontaneous reactivation of hepatitis B presenting as acute-onchronic liver failure. Hepatology 2011; 53: 774-80.

  15. Garg V1, Garg H, Khan A, Trehanpati N, Kumar A, Sharma BC, Sakhuja P, et al. Granulocyte colony-stimulating factor mobilizes CD34(+) cells and improves survival of patients with acute-on-chronic liver failure. Gastroenterology 2012; 142: 505-12.

  16. Garg H, Kumar A, Garg V, Sharma P, Sharma BC, Sarin SK. Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure. Dig Liver Dis 2012; 44: 166- 71.

  17. Chen T, He Y, Liu X, Yan Z, Wang K, Liu H. Nucleoside analogues improve the short-term and long-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure. Clin Exp Med 2012; 12(3): 159-64.

  18. Ma K, Guo W, Han M, Chen G, Chen T, Wu Z. Entecavir treatment prevents disease progression in hepatitis B virus-related acute-on-chronic liver failure: Establishment of a novel logistical regression model. Hepatol Int 2012;6(4):735-43.

  19. Sun LJ, Yu JW, Zhao YH, Kang P, Li SC. Influential factors of prognosis in lamivudine treatment for patients with acute-onchronic hepatitis B liver failure. J Gastroenterol Hepatol 2010; 25(3): 583-90.

  20. Zhang X, An Y, Jiang X, Xu M, Xu L, Chen S, Xi Y. Entecavir Versus Lamivudine therapy for patients with chronic hepatitis B-associated liver failure: a meta-analysis. Hepat Mon 2014; 14: e19164.

  21. Pan CQ, Zhang JX. Natural history and clinical consequences of hepatitis B Virus infection. Int J Med Sci 2005; 2: 36-40.

  22. Xu Z, Ren X, Liu Y, Li X, Bai S, Zhong Y, Wang L, et al. Association of hepatitis B virus mutations in basal core promoter and precore regions with severity of liver disease: an investigation of 793 Chinese patients with mild and severe chronic hepatitis B and acute-on-chronic liver failure. J Gastroenterol 2011; 46: 391-400.

  23. Xiao L, Zhou B, Gao H, Ma S, Yang G, Xu M, Abbott WG, et al. Hepatitis B virus genotype B with G1896A and A1762T/ G1764A mutations is associated with hepatitis B related acute-on-chronic liver failure. J Med Virol 2011; 83: 1544-50.

  24. Ren X, Xu Z, Liu Y, Li X, Bai S, Ding N, Zhong Y, et al. Hepatitis B virus genotype and basal core promoter/precore mutations are associated with hepatitis B-related acute-on-chronic liver failure without pre-existing liver cirrhosis. J Viral Hepat 2010; 17: 887-95.

  25. Zheng MH, Shi KQ, Fan YC, Li H, Ye C, Chen QQ, Chen YP. A model to determine 3-month mortality risk in patients with acute-on-chronic hepatitis B liver failure. Clin Gastroenterol Hepatol 2011; 9: 351-6.

  26. Sun QF, Ding JG, Xu DZ, Chen YP, Hong L, Ye ZY, Zheng MH, et al. Prediction of the prognosis of patients with acuteon- chronic hepatitis B liver failure using the model for endstage liver disease scoring system and a novel logistic regression model. J Viral Hepat 2009; 16: 464-70.

  27. Naiki T, Nakayama N, Mochida S, Oketani M, Takikawa Y, Suzuki K, Tada S, et al. Novel scoring system as a useful model to predict the outcome of patients with acute liver failure: Application to indication criteria for liver transplantation. Hepatol Res 2012; 42: 68-75.

  28. Stravitz RT, Ellerbe C, Durkalski V, Reuben A, Lisman T, Lee WM. Acute Liver Failure Study Group. Thrombocytopenia is associated with multi-organ system failure in patients with acute liver failure. Clin Gastroenterol Hepatol 2016; 14: 613-20.

  29. Lee WM. Recent developments in acute liver failure. Best Pract Res Clin Gastroenterol 2012; 26: 3-16.

  30. Lesurtel M, Graf R, Aleil B, Walther DJ, Tian Y, Jochum W, Gachet C, et al. Platelet-derived serotonin mediates liver regeneration. Science 2006; 312: 104-7.

  31. Hugenholtz GC, Adelmeijer J, Meijers JC, Porte RJ, Stravitz RT, Lisman T. An unbalance between von Willebrand factor and ADAMTS13 in acute liver failure: Implications for hemostasis and clinical outcome. Hepatology 2013; 58: 752-61.

  32. Ha JM, Sohn W, Cho JY, Pyo JH, Choi K, Sinn DH, Gwak GY, et al. Static and dynamic prognostic factors for hepatitis-Brelated acute-on-chronic liver failure. Clin Mol Hepatol 2015; 21: 232-41.

  33. Huo TI, Wu JC, Lin HC, Lee FY, Hou MC, Lee PC, Chang FY, et al. Evaluation of the increase in model for end-stage liver disease (Delta MELD) score over time as a prognostic predictor in patients with advanced cirrhosis: risk factor analysis and comparison with initial MELD and Child-Turcotte-Pugh score. J Hepatol 2005; 42: 826-32.

  34. Chamuleau RA, Wlodzimirow KA, Abu-Hanna A. Incorporating dynamics for predicting poor outcome in acute liver failure patients. World J Gastrointest Surg 2012; 4: 281-3.

  35. Gustot T, Fernandez J, Garcia E, Morando F, Caraceni P, Alessandria C, Laleman W, et al. Clinical course of acute-onchronic liver failure syndrome and effects on prognosis. Hepatology 2015; 62: 243-52.




2020     |     www.medigraphic.com