Abstract
This chapter describes the evaluations for the progression of chronic liver diseases, recent achievement for screening and early warning-parameters of AECHB, diagnosis criteria and grading standards of HBV ACLF.
-
1.
Several methods have been used to evaluate the progression of chronic liver diseases, including the Child–Turcotte–Pugh (CTP) score, MELD, MESO index, MELD-Na joint formula, iMELD formula, King’s College Hospital (KCH) score, Sequential Organ Failure Assessment (SOFA) score and the Tongji prognostic predictor model (TPPM) score.
-
2.
Technologies used for early screening of severe hepatitis B include gene-based diagnostic techniques, such as the polymerase chain reaction, gene sequence analysis, gene chips, and GWAS. Protein-based methods include two-dimensional gel electrophoresis and mass spectrometry; and epigenetic-based methods include assays of DNA methylation and histone modifications. In addition, meta-genomics and systematic biology have been used to analyze microbial sequence and function.
-
3.
Early-warning parameters for severe hepatitis B mainly include serum concentrations of ALT, AST, total bilirubin, albumin and pre-albumin, and cholinesterase; and measurements of blood ammonia, prothrombin time and prothrombin activity. Several new parameters related to severe hepatitis B have been identified, including gene mutations (e.g. HBV 1896 site mutation and 1762/1764 double mutation), genetic molecular targets (e.g. CXCL10-201 g/A, IL10-592 t/C, ESR1 IVS1-401 t/C, TBX21-1993 t/C, and ICAM1 R241-E469), immune factors (e.g. TNF-α, reactive oxygen species, reactive nitrogen species, sCD163, hfgl2, HLA-DR, NK cells, CTL, Th17 cells, Treg cells, PD-1/PD-L), and metabolic factors (e.g. lecithin, fat amides and bile acids).
-
4.
The clinical diagnosis of severe hepatitis B is mainly based on clinical manifestations, including jaundice, coagulation disorders, hepatic encephalopathy and ascites, and laboratory tests, including prothrombin time, prothrombin activity, international normalized ratio, AST/ALT ratio, and serum concentrations of albumin, bilirubin, cholinesterase, cholesterol, lactic acid, and alpha-fetoprotein.
-
5.
At present, there are differences among countries in the standard for diagnosing liver failure. In China, liver failure is referred to as severe hepatitis, whereas, in western counties, liver failure caused by viruses is diagnosed as fulminant hepatitis and refers only to acute liver failure. The main difference is that, in China, the concept of acute fulminant hepatitis has been extended to patients without encephalopathy. In contrast, hepatic encephalopathy II is a necessary condition to diagnose severe hepatitis in the United States, Europe and Japan.
-
6.
Liver failure can be subdivided into acute and chronic liver failure. Acute liver failure includes acute and sub-acute liver failure, and chronic liver failure includes acute-on-chronic and chronic decompensated liver failure. To date, hepatic encephalopathy has been necessary for the diagnosis of acute, but not chronic, liver failure, which is characterized by decompensated liver.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Volk ML, Marrero JA. Advances in critical care hepatology. Minerva Anestesiol. 2006;72(5):269–81.
Han MK, Hyzy R. Advances in critical care management of hepatic failure and insufficiency. Crit Care Med. 2006;34(9 Suppl):S225–31.
Wang Y, Changhai G. Liver failure. Beijing: People’s Medical Publishing House; 2002.
Rolando N, Philpott-Howard J, Williams R. Bacterial and fungal infection in acute liver failure. Semin Liver Dis. 1996;16(4):389–402.
Xue-mei L, Yu-xian U, Qing-hua M, et al. Characteristics of acid-base balance in patients with chronic severe hepatitis: analysis of 126 cases. Nat Med J China. 2006;30:2131–3.
Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ. 2005;172(3):367–79.
Schiodt FV, Ostapowicz G, Murray N, et al. Alpha-fetoprotein and prognosis in acute liver failure. Liver Transpl. 2006;12(12):1776–81.
Chinese Society of Infectious Diseases and Parasitology and Chinese Society of Hepatology of Chinese Medical Association. The programme of prevention and cure for viral hepatitis. Chin J Hepatol. 2000;8(4):324–9.
Liver Failure and Artificial Liver Group CSoID, Chinese Medical Association; Severe Liver Diseases and Artificial Liver Group CSoH, Chinese Medical Association. Diagnostic and treatment guidelines for liver failure (2012 version). Chin J Clin Infect Dis. 2012;5(6):321–7.
Williams R. Classification, etiology, and considerations of outcome in acute liver failure. Semin Liver Dis. 1996;16(4):343–8.
Trey C, Davidson CS. The management of fulminant hepatic failure. Prog Liver Dis. 1970;3:282–98.
Gimson AE, O’Grady J, Ede RJ, et al. Late onset hepatic failure: clinical, serological and histological features. Hepatology. 1986;6(2):288–94.
O’Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. 1993;342(8866):273–5.
Polson J, Lee WM. AASLD position paper: the management of acute liver failure. Hepatology. 2005;41(5):1179–97.
Jalan R, Williams R. Acute-on-chronic liver failure: pathophysiological basis of therapeutic options. Blood Purif. 2002;20(3):252–61.
Sarin SK, Kumar A, Almeida JA, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int. 2009;3(1):269–82.
Sarin SK, Kedarisetty CK, Abbas Z, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014. Hepatol Int. 2014;8(4):453–71.
Wang X, Sarin SK, Ning Q. Definition of ACLF and inclusion criteria for extra-hepatic organ failure. Hepatol Int. 2015;9(3):360–5.
Organization Committee of 13th Asia-Pacific Congress of Clinical Microbiology and Infection. 13th Asia-Pacific Congress of Clinical Microbiology and Infection Consensus Guidelines for diagnosis and treatment of liver failure. Hepatobiliary Pancreat Dis Int. 2013;12(4):346–54.
Jalan R, Gines P, Olson JC, et al. Acute-on chronic liver failure. J Hepatol. 2012;57(6):1336–48.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature B.V. and Huazhong University of Science and Technology Press
About this chapter
Cite this chapter
Chen, Z., Ning, Q., Chen, G. (2019). Early Prognostic Predictive System of AECHB and the Diagnosis of Severe Hepatitis B (Liver Failure). In: Ning, Q. (eds) Acute Exacerbation of Chronic Hepatitis B. Springer, Dordrecht. https://doi.org/10.1007/978-94-024-1603-9_3
Download citation
DOI: https://doi.org/10.1007/978-94-024-1603-9_3
Published:
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-024-1601-5
Online ISBN: 978-94-024-1603-9
eBook Packages: MedicineMedicine (R0)