Analysis of Prognostic Factors for Short-term Outcome in Patients with Hepatitis B Virus-related Acute-on-chronic Liver Failure Treated with Artificial Liver_West China Medical Journal

Authors：

 WangMing , ChenFang , XieYan ,  TangHong

Infectious Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

TangHong, Email: htang6198@hotmail.com

Keywords：

Acute-on-chronic liver failure; Artificial liver support system; Outcome; Logistic regression analysis

DOI：

10.7507/1002-0179.201600414

Video：

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Objective To learn the outcomes of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) cases after artificial liver support system (ALSS) treatment and the relevant factors correlated with the clinical outcomes. Methods In the period from January 2011 to June 2014, 321 patients with HBV-ACLF were admitted to West China Hospital. The clinical data at baseline, before and after treatment were analyzed by univariate and multivariate logistic regressions to identify the independent risk factors correlated with 30-day outcomes. Results Of all the 321 patients, 233 survived and 88 died by the end of a 30-day observation. The univariate analysis identified that the incidences of cirrhosis, hepatorenal syndrome and peritonitis in the death group were significantly higher (P<0.05). The model for end-stage liver disease values, white blood cells (WBC), blood ammonia, creatinine and total bilirubin (TBIL) at different stages in the death group were significantly higher than those in the survival group (P<0.05). In the death group, the HBV-DNA, TBIL decrease after triple ALSS treatments, baseline prothrombin time activity (PTA) and PTA level after triple ALSS treatments were significantly lower (P<0.05). The multivariate logistic regression indicated that WBC (OR=2.337, P<0.001) and TBIL level after triple ALSS treatments (OR=4.935, P<0.001) were independent predicting factors for death within 30 days after ALSS treatment; HBV-DNA (OR=0.403, P<0.001), the decrease of TBIL after triple ALSS treatments (OR=0.447, P<0.001) and PTA level after triple ALSS treatments (OR=0.332, P<0.001) were protecting factors for the 30-day prognosis. Conclusion These five factors including WBC, HBV-DNA, PTA, TBIL and TBIL decrease after triple ALSS treatments influence the short-term prognosis for HBV-ACLF patients, which are valuable for decision making in clinical practices.

Citation： WangMing, ChenFang, XieYan, TangHong. Analysis of Prognostic Factors for Short-term Outcome in Patients with Hepatitis B Virus-related Acute-on-chronic Liver Failure Treated with Artificial Liver. West China Medical Journal, 2016, 31(9): 1516-1520. doi: 10.7507/1002-0179.201600414 Copy

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14.	田方圆, 单静, 唐宽银, 等. 乙型肝炎相关性肝衰竭患者HBV DNA低水平复制及特异性抗体表达的临床意义[J]. 临床肝胆病杂志, 2014, 30(6):527-530.
15.	陈智. 肝衰竭发生与发展过程中的免疫机制研究进展[J]. 中华肝脏病杂志, 2012, 20(10):733-736.
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1. 王贵强, 王福生, 成军, 等. 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.
2. 刘晓燕, 胡瑾华, 王慧芬, 等. 1977例急性、亚急性、慢加急性肝衰竭患者的病因与转归分析[J]. 中华肝脏病杂志, 2008, 16(10):772-775.
3. Shen Y, Wang XL, Wang B, et al. Survival benefits with artificial liver support system for acute-on-chronic liver failure:a time series-based meta-analysis[J]. Medicine, 2016, 95(3):1-9.
4. 杨永峰, 魏林玲, 张宁, 等. 国内人工肝支持系统治疗重型肝炎疗效的Meta分析[J]. 中华肝脏病杂志, 2006, 14(10):732-734.
5. 张晶, 段钟平, 何金秋, 等. 人工肝治疗对重型肝病患者生存期的影响[J]. 中华肝脏病杂志, 2006, 14(9):647-651.
6. 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]. 中华临床感染病杂志, 2012, 5(6):321-327.
7. 王学浩, 李国强. 我国肝移植现状与面临的挑战[J]. 中华消化外科杂志, 2013, 12(9):641-643.
8. 蒋文涛, 王洪海, 郭庆军. 成人活体肝移植的现状[J]. 临床肝胆病杂志, 2015, 31(12):2023-2026.
9. 姜楠, 王建锋, 韩炜, 等. 人工肝支持系统的现状和发展[J]. 中华消化外科杂志, 2013, 12(8):637-640.
10. 王英杰. 人工肝在肝衰竭中的应用与评价[J]. 实用肝脏病杂志, 2013, 16(1):20-21.
11. 崔燕平, 刘凤华, 石庆凤, 等. 106例慢加急性肝衰竭合并肝性脑病患者预后影响因素的Logistic回归分析[J]. 临床肝胆病杂志, 2014, 30(10):992-995.
12. 谭淑燕, 江元森, 麦峻婷, 等. 人工肝治疗慢性乙型重型肝炎预后影响因素Logistic回归分析[J]. 广东医学, 2006, 27(7):979-980.
13. 叶佩燕, 杨宗国, 陈晓蓉, 等. HBV相关慢加急性肝衰竭不同分期的预后评价及影响因素分析[J]. 临床肝胆病杂志, 2013, 29(4):270-275.
14. 田方圆, 单静, 唐宽银, 等. 乙型肝炎相关性肝衰竭患者HBV DNA低水平复制及特异性抗体表达的临床意义[J]. 临床肝胆病杂志, 2014, 30(6):527-530.
15. 陈智. 肝衰竭发生与发展过程中的免疫机制研究进展[J]. 中华肝脏病杂志, 2012, 20(10):733-736.
16. dos Santos DC, Neves PC, Azeredo EL, et al. Activated lymphocytes and high liver expression of IFN-γ are associated with fulminant hepatic failure in patients[J]. Liver Int, 2012, 32(1):147-157.
17. Farci P, Diaz G, Chen Z, et al. B cell gene signature with massive intrahepatic production of antibodies to hepatitis B core antigen in hepatitis B virus-associated acute liver failure[J]. Proc Natl Acad Sci USA, 2010, 107(19):8766-8771.

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Analysis of Prognostic Factors for Short-term Outcome in Patients with Hepatitis B Virus-related Acute-on-chronic Liver Failure Treated with Artificial Liver

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