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Gut. 2018 Dec;67(12):2181-2191. doi: 10.1136/gutjnl-2017-314641. Epub 2017 Sep 19.

Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure.

Author information

1
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.
2
Department of Liver and Infectious Diseases, No. 302 Hospital of Chinese People's Liberation Army, Beijing, China.
3
Department of Liver and Infectious Diseases, The Third Affiliated Hospital, Sun YAT-SEN University, Guangzhou, China.
4
Department of Liver and Infectious Diseases, Beijing YouAn Hospital, Capital Medical University, Beijing, China.
5
Department of Liver and Infectious Diseases, Tianjin Third Central Hospital, Tianjin, China.
6
Department of Liver and Infectious Diseases, The First Hospital Affiliated of The Third Military Medical University, Chongqing, China.
7
Department of Liver and Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China.
8
Department of Liver and Infectious Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China.
9
Department of Liver and Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
10
Department of Gastroenterology, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China.
11
Department of Liver and Infectious Diseases, Xiangya Hospital Central South University, Changsha, China.
12
Department of Liver and Infectious Diseases, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China.
13
Department of Liver and Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
#
Contributed equally

Abstract

OBJECTIVE:

The definition of acute-on-chronic liver failure (ACLF) based on cirrhosis, irrespective of aetiology, remains controversial. This study aimed to clarify the clinicopathological characteristics of patients with hepatitis B virus-related ACLF (HBV-ACLF) in a prospective study and develop new diagnostic criteria and a prognostic score for such patients.

DESIGN:

The clinical data from 1322 hospitalised patients with acute decompensation of cirrhosis or severe liver injury due to chronic hepatitis B (CHB) at 13 liver centres in China were used to develop new diagnostic and prognostic criteria.

RESULTS:

Of the patients assessed using the Chronic Liver Failure Consortium criteria with the exception of cirrhosis, 391 patients with ACLF were identified: 92 with non-cirrhotic HBV-ACLF, 271 with cirrhotic HBV-ACLF and 28 with ACLF with cirrhosis caused by non-HBV aetiologies (non-HBV-ACLF). The short-term (28/90 days) mortality of the patients with HBV-ACLF were significantly higher than those of the patients with non-HBV-ACLF. Total bilirubin (TB) ≥12 mg/dL and an international normalised ratio (INR) ≥1.5 was proposed as an additional diagnostic indicator of HBV-ACLF, and 19.3% of patients with an HBV aetiology were additionally diagnosed with ACLF. The new prognostic score (0.741×INR+0.523×HBV-SOFA+0.026×age+0.003×TB) for short-term mortality was superior to five other scores based on both discovery and external validation studies.

CONCLUSIONS:

Regardless of the presence of cirrhosis, patients with CHB, TB ≥12 mg/dL and INR ≥1.5 should be diagnosed with ACLF. The new criteria diagnosed nearly 20% more patients with an HBV aetiology with ACLF, thus increasing their opportunity to receive timely intensive management.

KEYWORDS:

Hepatitis B; Liver Cirrhosis; Liver Failure

PMID:
28928275
DOI:
10.1136/gutjnl-2017-314641
[Indexed for MEDLINE]

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