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Expert Rev Gastroenterol Hepatol. 2018 Mar;12(3):295-302. doi: 10.1080/17474124.2018.1424540. Epub 2018 Jan 12.

Stratified alpha-fetoprotein pattern accurately predicts mortality in patients with acute-on-chronic hepatitis B liver failure.

Author information

1
a Department of Hepatology, Liver Research Center , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.
2
b Department of Neurology , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.
3
c Department of Clinical Laboratory , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.
4
d Institute of Hepatology , Wenzhou Medical University , Wenzhou , China.
5
e Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy , Ziekenhuis Oost-Limburg , Genk , Belgium.

Abstract

BACKGROUND:

Alpha-fetoprotein (AFP) has been shown to predict the prognosis of liver disease in several studies. This study aimed to evaluate the prognostic value of stratified AFP in patients with acute-on-chronic hepatitis B liver failure (ACHBLF).

METHODS:

A total of 192 patients were included and AFP were categorized into quartiles. The prognostic value was determined for overall survival (OS) and assessed by Kaplan-Meier analysis. Univariate and multivariate Cox proportional hazard regression analyses studied the association of all independent parameters with disease prognosis.

RESULTS:

The optimal cut-off points of AFP were: (Q1) 252.3-4800.0 ng/ml, (Q2) 76.0-252.2 ng/ml, (Q3) 18.6-75.9 ng/ml, and (Q4) 0.7-18.5 ng/ml. Based on the Kaplan-Meier analysis of the OS, each AFP quartile revealed a progressively worse OS and apparent separation (log-rank P = 0.006). The second-highest quartiles of AFP (Q2) always demonstrated an extremely favorable short-term survival. Combining the lowest AFP quartiles with a serum sodium < 131mmol/L or an INR ≥ 3.3 showed a poor outcome (90-days survival of 25.0% and 11.9% respectively).

CONCLUSIONS:

Stratified AFP could strengthen the predictive power for short-term survival of patients with ACHBLF. Combining AFP quartiles with low serum sodium and high INR may better predict poor outcome in ACHBLF patients.

KEYWORDS:

Alpha-fetoprotein; hepatitis B virus; hepatitis B virus-related-acute-on-chronic liver failure; liver disease; overall survival; risk factor

PMID:
29300103
DOI:
10.1080/17474124.2018.1424540
[Indexed for MEDLINE]

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