Establishment of a predictive model for the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure treated with plasma exchange and double plasma molecular adsorption system alone or in combination

Beibei HUANG; Ling NING; Wenyuan LI; Xiaowei ZHENG; Yue ZHANG; Shouwei JIANG; Zhenhua ZHANG; Lei LI

doi:10.3969/j.issn.1001-5256.2021.12.015

Volume 37 Issue 12

Dec. 2021

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Article Navigation > Journal of Clinical Hepatology > 2021 > 37(12): 2802-2807

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Establishment of a predictive model for the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure treated with plasma exchange and double plasma molecular adsorption system alone or in combination

DOI: 10.3969/j.issn.1001-5256.2021.12.015

1.
Department of Infectious Diseases, The Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China
2.
Department of Infectious and Liver Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China

Research funding:

Natural Science Foundation of Anhui Province (1208085QH147);

Artificial liver support system Special Fund project of Beijing Hepatology Charity Foundation (RGGJJ-2021-002)

Received Date: 2021-07-14
Accepted Date: 2021-08-16
Published Date: 2021-12-20

Abstract

Abstract

Objective To observe the 24-week survival status of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) treated with plasma exchange (PE) and double plasma molecular adsorption system (DPMAS) alone or in combination, and to establish a predictive model for 24-week prognosis. Methods Related clinical data were collected from 133 patients with HBV-ACLF who received PE and DPMAS alone or in combination in The Affiliated Provincial Hospital of Anhui Medical University from January 2015 to December 2019, and according to the survival status at the 24-week follow-up after treatment, they were divided into survival group with 71 patients and death group with 62 patients. A total of 55 patients with HBV-ACLF who received PE and DPMAS alone or in combination in The Second Affiliated Hospital of Anhui Medical University from January 2018 to January 2020 were enrolled as validation group to validate the performance of the model. Related clinical data included mode of artificial liver support therapy, age, sex, total bilirubin (TBil), international normalized ratio (INR), creatinine (Cr), serum sodium, platelet count (PLT), albumin (Alb), and presence or absence of ascites, hepatorenal syndrome, hepatic encephalopathy, and gastrointestinal bleeding. The t-test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank-sum test was used for comparison of continuous data with skewed distribution between two groups; the chi-square test and the Fisher's exact test were used for comparison of categorical data between groups. The Cox regression model was used to analyze the influencing factors for the prognosis of HBV-ACLF patients after PE and DPMAS alone or in combination and establish a predictive model; the receiver operator characteristic (ROC) curve was plotted and the DeLong method was used to compare the area under the ROC curve (AUC) between the new predictive model and Model for End-Stage Liver Disease (MELD)/MELD combined with serum sodium concentration (MELD-Na) scores. Results At 24 weeks after treatment, 71 patients survived and 62 patients died in the modeling group. The Cox regression analysis showed age (hazard ratio [HR]=1.030, P=0.013), TBil (HR=1.018, P < 0.001), INR (HR=1.517, P < 0.001), and PLT (HR=0.993, P=0.04) were independent influencing factors for 24-week survival. According to the results of the Cox regression analysis, a prognostic model for HBV-ACLF patients treated with PE and DPMAS alone or in combination was established as ATIP=0.029×age (years)+0.018×TBil (mg/dL)+0.417×INR-0.007×PLT (10⁹/L). Both the modeling group and the validation group showed that the ATIP model had a better predictive performance than MELD and MELD-NA scores(all P < 0.05). Conclusion Age, TBil, INR, and PLT are independent influencing factors for the 24-week survival of HBV-ACLF patients treated with PE and DPMAS alone or in combination, and the ATIP model has a good performance in predicting the 24-week prognosis of HBV-ACLF patients treated with PE and DPMAS alone or in combination.
- Liver Failure,
- Hepatitis B virus,
- Liver, Artificial,
- Prognosis

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References(29)

References

[1]	LIU J, FAN D. Hepatitis B in China[J]. Lancet, 2007, 369(9573): 1582-1583. DOI: 10.1016/S0140-6736(07)60723-5.
[2]	Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure[J]. J Clin Hepatol, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007. 中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35(1): 38-44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.
[3]	SARIN SK, CHOUDHURY A. Acute-on-chronic liver failure: Terminology, mechanisms and management[J]. Nat Rev Gastroenterol Hepatol, 2016, 13(3): 131-149. DOI: 10.1038/nrgastro.2015.219.
[4]	REEVES HM, WINTERS JL. The mechanisms of action of plasma exchange[J]. Br J Haematol, 2014, 164(3): 342-351. DOI: 10.1111/bjh.12629.
[5]	YAO J, LI S, ZHOU L, et al. Therapeutic effect of double plasma molecular adsorption system and sequential half-dose plasma exchange in patients with HBV-related acute-on-chronic liver failure[J]. J Clin Apher, 2019, 34(4): 392-398. DOI: 10.1002/jca.21690.
[6]	KAMATH PS, WIESNER RH, MALINCHOC M, et al. A model to predict survival in patients with end-stage liver disease[J]. Hepatology, 2001, 33(2): 464-470. DOI: 10.1053/jhep.2001.22172.
[7]	BIGGINS SW, KIM WR, TERRAULT NA, et al. Evidence-based incorporation of serum sodium concentration into MELD[J]. Gastroenterology, 2006, 130(6): 1652-1660. DOI: 10.1053/j.gastro.2006.02.010.
[8]	ZOULIM F, LOCAMINI S. Hepatitis B virus resistance to nucleos(t)ide analogues[J]. Gastroenterology, 2009, 137: 1593-1608. e1-2. DOI: 10.1053/j.gastro.2009.08.063.
[9]	LING Q, XU X, WEI Q, et al. Downgrading MELD improves the outcomes after liver transplantation in patients with acute-on-chronic hepatitis B liver failure[J]. PLoS One, 2012, 7(1): e30322. DOI: 10.1371/journal.pone.0030322.
[10]	YU JW, SUN LJ, ZHAO YH, et al. Prediction value of model for end-stage liver disease scoring system on prognosis in patients with acute-on-chronic hepatitis B liver failure after plasma exchange and lamivudine treatment[J]. J Gastroenterol Hepatol, 2008, 23(8 Pt 1): 1242-1249. DOI: 10.1111/j.1440-1746.2008.05484.x.
[11]	CHEN JJ, HUANG JR, YANG Q, et al. Plasma exchange-centered artificial liver support system in hepatitis B virus-related acute-on-chronic liver failure: A nationwide prospective multicenter study in China[J]. Hepatobiliary Pancreat Dis Int, 2016, 15(3): 275-281. DOI: 10.1016/s1499-3872(16)60084-x.
[12]	XU X, LIU X, LING Q, et al. Artificial liver support system combined with liver transplantation in the treatment of patients with acute-on-chronic liver failure[J]. PLoS One, 2013, 8(3): e58738. DOI: 10.1371/journal.pone.0058738.
[13]	WIESNER R, EDWARDS E, FREEMAN R, et al. Model for end-stage liver disease (MELD) and allocation of donor livers[J]. Gastroenterology, 2003, 124(1): 91-96. DOI: 10.1053/gast.2003.50016.
[14]	ROUILLARD SS, BASS NM, ROBERTS JP, et al. Severe hyperbilirubinemia after creation of transjugular intrahepatic portosystemic shunts: Natural history and predictors of outcome[J]. Ann Intern Med, 1998, 128(5): 374-377. DOI: 10.7326/0003-4819-128-5-199803010-00006.
[15]	INTAGLIATA NM, DAVIS J, CALDWELL SH. Coagulation pathways, hemostasis, and thrombosis in liver failure[J]. Semin Respir Crit Care Med, 2018, 39(5): 598-608. DOI: 10.1055/s-0038-1673658.
[16]	HARUKI K, SHIBA H, SAITO N, et al. Risk stratification using a novel liver functional reserve score of combination prothrombin time-international normalized ratio to albumin ratio and albumin in patients with hepatocellular carcinoma[J]. Surgery, 2018, 164(3): 404-410. DOI: 10.1016/j.surg.2018.02.022.
[17]	HU XP, GAO J. International normalized ratio and Model for End-stage Liver Disease score predict short-term outcome in cirrhotic patients after the resolution of hepatic encephalopathy[J]. World J Gastroenterol, 2019, 25(26): 3426-3437. DOI: 10.3748/wjg.v25.i26.3426.
[18]	O'LEARY JG, GREENBERG CS, PATTON HM, et al. AGA clinical practice update: Coagulation in cirrhosis[J]. Gastroenterology, 2019, 157(1): 34-43. e1. DOI: 10.1053/j.gastro.2019.03.070.
[19]	XIA Q, DAI X, ZHANG Y, et al. A modified MELD model for Chinese pre-ACLF and ACLF patients and it reveals poor prognosis in pre-ACLF patients[J]. PLoS One, 2013, 8(6): e64379. DOI: 10.1371/journal.pone.0064379.
[20]	LU XC, LU D, PAN Y. Clinical significance of platelet parameters in diagnosis and treatment of acute leukemia[J]. Int J Lab Med, 2006, 27(10): 870-871, 873. DOI: 10.3969/j.issn.1673-4130.2006.10.003. 陆小婵, 卢冬, 潘云. 血小板参数在急性白血病疗效观察中的应用[J]. 国际检验医学杂志, 2006, 27(10): 870-871, 873. DOI: 10.3969/j.issn.1673-4130.2006.10.003.
[21]	PECK-RADOSAVLJEVIC M, WICHLAS M, ZACHERL J, et al. Thrombopoietin induces rapid resolution of thrombocytopenia after orthotopic liver transplantation through increased platelet production[J]. Blood, 2000, 95(3): 795-801. DOI: 10.1182/blood.V95.3.795.003k25_795_801
[22]	HITCHCOCK IS, KAUSHANSKY K. Thrombopoietin from beginning to end[J]. Br J Haematol, 2014, 165(2): 259-268. DOI: 10.1111/bjh.12772.
[23]	OLARIU M, OLARIU C, OLTEANU D. Thrombocytopenia in chronic hepatitis C[J]. J Gastrointestin Liver Dis, 2010, 19(4): 381-385. http://193.231.29.96/jgld/2010/4/7.pdf
[24]	SAKAI K, IWAO T, OHO K, et al. Propranolol ameliorates thrombocytopenia in patients with cirrhosis[J]. J Gastroenterol, 2002, 37(2): 112-118. DOI: 10.1007/s005350200005.
[25]	MA Z, WU Y. Current status of liver failure treatment[J]. J Clin Hepatol, 2016, 32(9) : 1668-1672. DOI: 10.3969/ j.issn.1001- 5256.2016.09.007. 马臻, 乌云. 肝衰竭的治疗现状[J]. 临床肝胆病杂志, 2016, 32(9): 1668- 1672. DOI: 10.3969/ j.issn.1001- 5256.2016.09.007.
[26]	XU SS, WEI XH, LIN W, et al. Clinical significance of platelet count and its dynamic change in patients with acute- on-chronic liver failure[J]. J CIin Hepatol, 2018, 34(4): 810-813. DOI: 10. 3969/ j. issn. 1001- 5256. 2018. 04. 023. 许姗姗, 韦新焕, 林伟, 等. 慢加急性肝衰竭患者血小板计数及其动态变化的临床意义[J]. 临床肝胆病杂志, 2018, 34(4): 810-813. DOI: 10.3969/j.issn.1001-5256.2018.04.023.
[27]	SHI XX, ZHANG YQ, ZHU P, et al. Prognostic risk factors in patients with acute- on- chronic hepatitis B liver failure[J]. J Clin Hepatol, 2016, 32(4): 700-705. DOI: 10.3969/j.issn.1001-5256. 2016. 04. 018. 石新星, 张艳琼, 朱鹏, 等. 乙型肝炎相关慢加急性肝衰竭患者预后的危险因素分析[J]. 临床肝胆病杂志, 2016, 32(4): 700-705. DOI: 10.3969/j.issn.1001-5256.2016.04.018
[28]	LI WY, ZHANG MX, QI TT, et al. The potential factors contributing to thrombocytopenia in acute-on-chronic liver failure patients[J]. Chin Hepatol, 2015, 20(6): 457-461. DOI: 10.3969/j.issn.1008-1704.2015.06.009 李文燕, 张明霞, 祁婷婷, 等. 慢加急性肝衰竭患者血小板减少的可能原因[J]. 肝脏, 2015, 20(6): 457-461. DOI: 10.3969/j.issn.1008-1704.2015.06.009
[29]	LESURTEL M, GRAF R, ALEIL B, et al. Platelet-derived serotonin mediates liver regeneration[J]. Science, 2006, 312(5770): 104-107. DOI: 10.1126/science.1123842.

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Establishment of a predictive model for the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure treated with plasma exchange and double plasma molecular adsorption system alone or in combination

DOI: 10.3969/j.issn.1001-5256.2021.12.015

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