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Sci Rep. 2016 May 5;6:25487. doi: 10.1038/srep25487.

Characteristics, Diagnosis and Prognosis of Acute-on-Chronic Liver Failure in Cirrhosis Associated to Hepatitis B.

Li H1,2,3, Chen LY1,2,3, Zhang NN1,2,3, Li ST1,2,3, Zeng B1,2,3, Pavesi M4, Amorós À4, Mookerjee RP5, Xia Q6, Xue F6, Ma X1,2,3, Hua J1,2,3, Sheng L1,2,3, Qiu DK1,2,3, Xie Q7, Foster GR8, Dusheiko G5, Moreau R9, Gines P10, Arroyo V10,11, Jalan R5.

Author information

1
Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
2
Shanghai Institute of Digestive Disease, Shanghai, China.
3
Key Laboratory of Gastroenterology &Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
4
Data Management Centre, European Foundation for the study of Chronic LIver Failure (EF-CLIF), Barcelona, Spain.
5
Liver Failure Group, Institute for Liver and Digestive Health, UCL, London, United Kingdom.
6
Department of Liver Surgery and Liver Transplantation, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
7
Department of Infectious Disease, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
8
Queen Mary's University of London, Barts Health, United Kingdom.
9
Service d'Hepatologie, Hopital Beaujon, Clichy, France.
10
Liver Unit, Hospital Clinic, Barcelona, Spain.
11
European Foundation for the study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain.

Abstract

The diagnostic and prognostic criteria of acute-on-chronic liver failure (ACLF) were developed in patients with no Hepatitis B virus (HBV) cirrhosis (CANONIC study). The aims of this study were to evaluate whether the diagnostic (CLIF-C organ failure score; CLIF-C OFs) criteria can be used to classify patients; and the prognostic score (CLIF-C ACLF score) could be used to provide prognostic information in HBV cirrhotic patients with ACLF. 890 HBV associated cirrhotic patients with acute decompensation (AD) were enrolled. Using the CLIF-C OFs, 33.7% (300 patients) were diagnosed as ACLF. ACLF was more common in the younger patients and in those with no previous history of decompensation. The most common organ failures were 'hepatic' and 'coagulation'. As in the CANONIC study, 90-day mortality was extremely low in the non-ACLF patients compared with ACLF patients (4.6% vs 50%, p < 0.0001). ACLF grade and white cell count, were independent predictors of mortality. CLIF-C ACLFs accurately predicted short-term mortality, significantly better than the MELDs and a disease specific score generated for the HBV patients. Current study indicates that ACLF is a clinically and pathophysiology distinct even in HBV patients. Consequently, diagnostic criteria, prognostic scores and probably the management of ACLF should base on similar principles.

PMID:
27146801
PMCID:
PMC4857102
DOI:
10.1038/srep25487
[Indexed for MEDLINE]
Free PMC Article

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