中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 1
Jan.  2023
Turn off MathJax
Article Contents

Clinical characteristics and prognosis of acute on chronic liver failure in patients with recompensatory hepatitis B cirrhosis

DOI: 10.3969/j.issn.1001-5256.2023.01.011
Research funding:

Tianjin Key Medical Discipline (Specialty) Construction Project (TJYXZDXK-034A);

Tianjin Health Project (TJWJ2022XK029)

More Information
  • Corresponding author: LIANG Jing, haolele77@sina.com(ORCID: 0000-0001-5114-9030)
  • Received Date: 2022-07-07
  • Accepted Date: 2022-08-26
  • Published Date: 2023-01-20
  •   Objective  To assess the clinical characteristics of acute-on-chronic liver failure in patients with recompensatory hepatitis B cirrhosis.  Methods  A total of 180 patients with acute-on-chronic liver failure hospitalized in Tianjin Third Central Hospital from September 2013 to September 2021 were retrospectively collected, with 110 patients had compensatory hepatitis B cirrhosis and 70 patients had compensatory hepatitis B cirrhosis and used as the control. Their causes, clinical biochemical indicators, complication rate, and prognosis were compared. The Chi-square test or Fisher's exact test was used for comparison of categorical variables between groups, and the Mann-Whitney U test was performed for analysis of the continuous variables. Kaplan-Meier curves and Log-rank test were used for survival of patients.  Results  The incidence of hepatorenal syndrome (χ2=4.618, P=0.032), infection (χ2=6.712, P=0.010), Cr (Z =-4.508, P < 0.001), and PCT (Z=-2.052, P=0.040) were all higher, whereas GGT (Z=-2.042, P=0.041), Na (Z=-2.001, P=0.045), FBS (Z=-3.065, P=0.002), and TC (Z=-4.268, P < 0.001) were all lower in the recompensation group than in the control group of patients. However, 90-day mortality rate (χ2=3.366, P=0.067) and 1-year mortality rate (χ2=1.893, P=0.169), 90-day survival (χ2=2.68, P=0.100), and 1-year survival (χ2=2.074, P=0.150) were not statistically significant difference.  Conclusion  Compared with compensatory hepatitis B cirrhosis, patients with recompensatory cirrhosis had an increased risk in developing hepatorenal syndrome, infection, and increased creatinine level after acute-on-chronic liver failure, although there was no statistically significant difference in 90-days and 1-year survival of patients.

     

  • loading
  • [1]
    LOK AS. Hepatitis: Long-term therapy of chronic hepatitis B reverses cirrhosis[J]. Nat Rev Gastroenterol Hepatol, 2013, 10(4): 199-200. DOI: 10.1038/nrgastro.2013.13.
    [2]
    MARCELLIN P, ASSELAH T. Long-term therapy for chronic hepatitis B: hepatitis B virus DNA suppression leading to cirrhosis reversal[J]. J Gastroenterol Hepatol, 2013, 28(6): 912-923. DOI: 10.1111/jgh.12213.
    [3]
    DIENSTAG JL, GOLDIN RD, HEATHCOTE EJ, et al. Histological outcome during long-term lamivudine therapy[J]. Gastroenterology, 2003, 124(1): 105-117. DOI: 10.1053/gast.2003.50013.
    [4]
    HADZIYANNIS SJ, TASSOPOULOS NC, HEATHCOTE EJ, et al. Long-term therapy with adefovir dipivoxil for HBeAg-negative chronic hepatitis B for up to 5 years[J]. Gastroenterology, 2006, 131(6): 1743-1751. DOI: 10.1053/j.gastro.2006.09.020.
    [5]
    KONG Y, SUN Y, ZHOU J, et al. Early steep decline of liver stiffness predicts histological reversal of fibrosis in chronic hepatitis B patients treated with entecavir[J]. J Viral Hepat, 2019, 26(5): 576-585. DOI: 10.1111/jvh.13058.
    [6]
    BUTI M, FUNG S, GANE E, et al. Long-term clinical outcomes in cirrhotic chronic hepatitis B patients treated with tenofovir disoproxil fumarate for up to 5 years[J]. Hepatol Int, 2015, 9(2): 243-250. DOI: 10.1007/s12072-015-9614-4.
    [7]
    SARIN SK, CHOUDHURY A, SHARMA MK, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update[J]. Hepatol Int, 2019, 13(4): 353-390. DOI: 10.1007/s12072-019-09946-3.
    [8]
    de FRANCHIS R, BOSCH J, GARCIA-TSAO G, et al. Baveno VⅡ - Renewing consensus in portal hypertension[J]. J Hepatol, 2022, 76(4): 959-974. DOI: 10.1016/j.jhep.2021.12.022.
    [9]
    Chinese Society of Hepatology, Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B (2010 version)[J]. J Clin Hepatol, 2011, 27(1): Ⅰ-ⅩⅥ. https://www.cnki.com.cn/Article/CJFDTOTAL-LCGD201108002.htm

    中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2010版)[J]. 临床肝胆病杂志, 2011, 27(1): Ⅰ-ⅩⅥ. https://www.cnki.com.cn/Article/CJFDTOTAL-LCGD201108002.htm
    [10]
    Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B: a 2015 update[J]. J Clin Hepatol, 2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002.

    中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志, 2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002.
    [11]
    Group of Liver Failure and Artificial Liver, Chinese Society of Infectious Diseases, Chinese Medical Association; Group of severe Liver disease and Artificial Liver, Chinese Society of Hepatology, Chinese Medical Association. Guidelines for diagnosis and treatment of hepatic failure (2012 edition)[J]. Inter J Epidemiol Infect Dis, 2013, 40(1): 1-7. DOI: 10.3760/cma.j.issn.1673-4149.2013.01.001.

    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(2012年版)[J]. 国际流行病学传染病学杂志, 2013, 40(1): 1-7. DOI: 10.3760/cma.j.issn.1673-4149.2013.01.001.
    [12]
    Chinese Society of Hepatology, Chinese Medical Association. Chinese guidelines on the management of liver cirrhosis[J]. J Clin Hepatol, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.

    中华医学会肝病学分会. 肝硬化诊治指南[J]. 临床肝胆病杂志, 2019, 35(11): 2408-2425. DOI: 10.3969/j.issn.1001-5256.2019.11.006.
    [13]
    CAO ZJ, ZHANG CX, XIE Q. Paving the way to improve clinical management of acute-on-chronic liver failure using international criteria[J]. J Clin Hepatol, 2021, 37(4): 745-751. DOI: 10.3969/j.issn.1001-5256.2021.04.001.

    曹竹君, 张宸溪, 谢青. 慢加急性肝衰竭的国际标准与临床管理优化[J]. 临床肝胆病杂志, 2021, 37(4): 745-751. DOI: 10.3969/j.issn.1001-5256.2021.04.001.
    [14]
    MOREAU R, JALAN R, GINES P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis[J]. Gastroenterology, 2013, 144(7): 1426-1437. DOI: 10.1053/j.gastro.2013.02.042.
    [15]
    SHI Y, YANG Y, HU Y, et al. Acute-on-chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults[J]. Hepatology, 2015, 62(1): 232-242. DOI: 10.1002/hep.27795.
    [16]
    YIN S, WANG SJ, GU WY, et al. Risk of different precipitating events for progressing to acute-on-chronic liver failure in HBV-related cirrhotic patients[J]. J Dig Dis, 2017, 18(5): 292-301. DOI: 10.1111/1751-2980.12480.
    [17]
    CLÀRIA J, STAUBER RE, COENRAAD MJ, et al. Systemic inflammation in decompensated cirrhosis: Characterization and role in acute-on-chronic liver failure[J]. Hepatology, 2016, 64(4): 1249-1264. DOI: 10.1002/hep.28740.
    [18]
    DIRCHWOLF M, PODHORZER A, MARINO M, et al. Immune dysfunction in cirrhosis: Distinct cytokines phenotypes according to cirrhosis severity[J]. Cytokine, 2016, 77: 14-25. DOI: 10.1016/j.cyto.2015.10.006.
    [19]
    ALBILLOS A, LARIO M, ÁLVAREZ-MON M. Cirrhosis-associated immune dysfunction: distinctive features and clinical relevance[J]. J Hepatol, 2014, 61(6): 1385-1396. DOI: 10.1016/j.jhep.2014.08.010.
    [20]
    THABUT D, MASSARD J, GANGLOFF A, et al. Model for end-stage liver disease score and systemic inflammatory response are major prognostic factors in patients with cirrhosis and acute functional renal failure[J]. Hepatology, 2007, 46(6): 1872-1882. DOI: 10.1002/hep.21920.
    [21]
    FERNÁNDEZ J, ACEVEDO J, WIEST R, et al. Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis[J]. Gut, 2018, 67(10): 1870-1880. DOI: 10.1136/gutjnl-2017-314240.
    [22]
    XU KC. Liver function detection technology and evaluation[M]//WANG BE, ZHANG DF. Modern Hepatology. Beijing: Science Press, 2003: 192.

    徐克成. 肝功能检测技术及评价[M]//王宝恩, 张定凤. 现代肝脏病学. 北京: 科学出版社, 2003: 192.
    [23]
    MEDZHITOV R, SCHNEIDER DS, SOARES MP. Disease tolerance as a defense strategy[J]. Science, 2012, 335(6071): 936-941. DOI: 10.1126/science.1214935.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(3)  / Tables(2)

    Article Metrics

    Article views (1839) PDF downloads(118) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return