Clinical features of HBV-associated acute-on-chronic liver failure induced by discontinuation of nucleoside analogues

Objective To investigate the clinical features of patients with HBV- associated acute- on- chronic liver failure( HBV-ACLF) induced by the discontinuation of necleos( t) ide analogues. Methods A retrospective analysis was performed for 698 patients with a definite diagnosis of HBV- ACLF in The 302 Hospital of PLA from January 2014 to April 2016,and among these patients,150( discontinuation group) had acute- on- chronic liver failure( ACLF) induced by discontinuation,396( previously untreated group) had not received antiviral therapy when they developed this disease for the first time,and the other 152 patients with ACLF caused by other reasons were enrolled as controls. The causative factors,underlying diseases,family history,serum hepatitis B markers,prognosis,and initial onset were summarized,and the drugs used and discontinuation time were recorded for patients who stopped taking necleos( t) ide analogues. The chi-square test was used for the comparison of categorical data between groups. Results Among the 698 patients,355( 50. 86%) had a family history of chronic hepatitis B( CHB),and 93 patients( 62. 00%) in the discontinuation group had a family history of CHB. Among the 150 patients in the discontinuation group,27( 18. 00%) had an underlying disease of chronic hepatitis,among whom 12( 44. 44%) had a family history of CHB,which was significantly lower than the overall level( χ2= 2. 57,P = 0. 07); 123( 82. 00%) had an underlying disease of liver cirrhosis( compensated),among whom 81( 65. 85%) had a family history of CHB,which was significantly higher than the overall level( χ2= 48. 77,P < 0. 001). Of all the patients in the discontinuation group,77. 33%( 116/150) developed the disease within 1 year after discontinuation,and 21. 33%( 32/150) developed the disease during the second year after discontinuation. The HBe Ag- negative patients accounted for 47. 33%( 71/150). In the discontinuation group and previously untreated group,the patients with an underlying disease of chronic hepatitis showed a significantly higher cure and improvement rate than those with an underlying disease of liver cirrhosis( the discontinuation group: 88. 89% vs 53. 66%,χ2= 11. 450,P = 0. 001; the previously untreated group: 71. 79% vs 59. 50%,χ2= 5. 355,P =0. 021). Conclusion Discontinuation of necleos( t) ide analogues results in an increased proportion of patients with liver failure. Long-term antiviral therapy is very important,especially for patients with liver cirrhosis.