Complications constitute a major risk factor for mortality in hepatitis B virus-related acute-on-chronic liver failure patients: a multi-national study from the Asia-Pacific region

Chen T 1 , Yang Z 1 , Choudhury AK 2 , Al Mahtab M 3 , Li J 4 , Chen Y 5 Show all authors , Tan SS 6 , Han T 7 , Hu J 8 , Hamid SS 9 , Huei LG 10 , Ghazinian H 11 , Nan Y 12 , Chawla YK 13 , Yuen MF 14 , Devarbhavi H 15 , Shukla A 16 , Abbas Z 17 , Sahu M 18 , Dokmeci AK 19 , Lesmana LA 20 , Lesmana CRA 20 , Xin S 8 , Duan Z 5 , Guo W 1 , Ma K 1 , Zhang Z 1 , Cheng Q 1 , Jia J 21 , Sharma BC 22 , Sarin SK 23 , Ning Q 24

Affiliations 

  • 1 Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, People's Republic of China
  • 2 Departments of Hepatology and Transplant, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
  • 3 Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • 4 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
  • 5 Youan Hospital, Capital Medical University, Beijing, China
  • 6 Department of Hepatology, Selayang Hospital, Batu Caves, Malaysia
  • 7 Department of Gastroenterology, Third Central Hospital, Tianjing, China
  • 8 Liver Failure Treatment and Research Center, the Fifth Medical Center, Chinese PLA General Hospital, Beijing, China
  • 9 Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
  • 10 National University of Singapore and National University Hospital, Singapore, Singapore
  • 11 Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia
  • 12 Department of Hepatology, Hebei Medical University, Shijiazhuang, China
  • 13 Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 14 Department of Medicine, Queen Mary Hospital, Hong Kong, China
  • 15 Department of Gastroenterology and Hepatology, St John Medical College, Bangalore, India
  • 16 Department of Hepatology, KEM Hospital, Mumbai, India
  • 17 Department of Hepatogastroenterology, Ziauddin University, Karachi, Pakistan
  • 18 Department of Gastroenterology and Hepatology, IMS and SUM Hospital, Odisa, India
  • 19 Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
  • 20 Medistra Hospital, Digestive Disease and GI Oncology Center, Jakarta, Indonesia
  • 21 Liver Research Center, Beijing Friendship Hospital, Beijing, China
  • 22 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
  • 23 Departments of Hepatology and Transplant, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com
  • 24 Department of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, People's Republic of China. qning@vip.sina.com
Hepatol Int, 2019 Nov;13(6):695-705.
PMID: 31650510 DOI: 10.1007/s12072-019-09992-x

Abstract

BACKGROUND AND AIM: Cirrhosis is a controversial determinant of mortality in HBV-related acute-on-chronic liver failure (HBV-ACLF). The present study aimed to explore the effects of cirrhosis and the associated risk factors, especially its complications, on the outcome of HBV-ACLF.

METHODS: A prospective-retrospective cohort of 985 patients was identified from the APASL-ACLF Research Consortium (AARC) database and the Chinese Study Group. Complications of ACLF (ascites, infection, hepatorenal syndrome, hepatic encephalopathy, upper gastrointestinal bleeding) as well as cirrhosis and the current main prognostic models were measured for their predictive ability for 28- or 90-day mortality.

RESULTS: A total of 709 patients with HBV-ACLF as defined by the AARC criteria were enrolled. Among these HBV-ACLF patients, the cirrhotic group showed significantly higher mortality and complications than the non-cirrhotic group. A total of 36.1% and 40.1% of patients met the European Association for the Study of Liver (EASL)-Chronic Liver Failure consortium (CLIF-C) criteria in the non-cirrhotic and cirrhotic groups, respectively; these patients had significantly higher rates of mortality and complications than those who did not satisfy the CLIF-C criteria. Furthermore, among patients who did not meet the CLIF-C criteria, the cirrhotic group exhibited higher mortality and complication rates than the non-cirrhotic group, without significant differences in organ failure. The Tongji prognostic predictor model score (TPPMs), which set the number of complications as one of the determinants, showed comparable or superior ability to the Chinese Group on the Study of Severe Hepatitis B-ACLF score (COSSH-ACLFs), APASL-ACLF Research Consortium score (AARC-ACLFs), CLIF-C organ failure score (CLIF-C OFs), CLIF-C-ACLF score (CLIF-C-ACLFs), Model for End-Stage Liver Disease score (MELDs) and MELD-sodium score (MELD-Nas) in HBV-ACLF patients, especially in cirrhotic HBV--ACLF patients. Patients with two (OR 4.70, 1.88) or three (OR 8.27, 2.65) complications had a significantly higher risk of 28- or 90-day mortality, respectively.

CONCLUSION: The presence of complications is a major risk factor for mortality in HBV-ACLF patients. TPPM possesses high predictive ability in HBV-ACLF patients, especially in cirrhotic HBV-ACLF patients.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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