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Hepatology International

, Volume 13, Issue 6, pp 695–705 | Cite as

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

  • Tao Chen
  • Zhongyuan Yang
  • Ashok Kumar Choudhury
  • Mamun Al Mahtab
  • Jun Li
  • Yu Chen
  • Soek-Siam Tan
  • Tao Han
  • Jinhua Hu
  • Saeed S. Hamid
  • Lee Guan Huei
  • Hasmik Ghazinian
  • Yuemin Nan
  • Yogesh K. Chawla
  • Man-Fung Yuen
  • Harshad Devarbhavi
  • Akash Shukla
  • Zaigham Abbas
  • Manoj Sahu
  • A. K. Dokmeci
  • Laurentias A. Lesmana
  • Cosmas Rinaldi A. Lesmana
  • Shaojie Xin
  • Zhongping Duan
  • Wei Guo
  • Ke Ma
  • Zhongwei Zhang
  • Qiuyu Cheng
  • Jidong Jia
  • B. C. Sharma
  • Shiv Kumar SarinEmail author
  • Qin NingEmail author
Original Article
  • 146 Downloads

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.

Keywords

HBV Acute-on-chronic liver failure Cirrhosis Prognostic scores Mortality 

Abbreviations

ACLF

Acute-on-chronic liver failure

HBV–ACLF

HBV-related acute-on-chronic liver failure

AARC

Asia-pacific association for the study of liver ACLF research consortium

APASL

ACLF research consortium score (AARC–ACLFs)

CLIF-C OF

Chronic liver failure consortium organ failure

CLIF-C ACLF

CLIF-C acute-on-chronic liver failure

MELD

Model for end-stage liver disease

MELD–Na

MELD–sodium score

TPPM

Tongji prognostic predictor model

COSSH–ACLF

Chinese Group on the Study of Severe Hepatitis B-ACLF

AUROC

Area under the receiver operating characteristic curve

Notes

Acknowledgements

The authors would like to thank Professor Osamu Yokosuka, Prof. Sombat Treeprasertsuk and Prof. Gamal Shiha for their support in valuable discussion and editing.

Funding

This study was partially supported by the National Thirteenth “Five Years” Project in Science and Technology of China (2017ZX10202201, 2018ZX10302-206).

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest about this work.

Informed consent in studies with human subjects

The data were collected using a pre-defined, web-based proforma in the Asia–pacific Association for the Study of Liver ACLF Research Consortium (AARC) database (http://www.aclf.in). Approval from the institutional ethics committees was obtained. The data were annotated and encrypted before analysis. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Asia–pacific Association for the Study of Liver ACLF Research Consortium) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.

Supplementary material

12072_2019_9992_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 28 kb)

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Copyright information

© Asian Pacific Association for the Study of the Liver 2019

Authors and Affiliations

  • Tao Chen
    • 1
  • Zhongyuan Yang
    • 1
  • Ashok Kumar Choudhury
    • 2
  • Mamun Al Mahtab
    • 3
  • Jun Li
    • 4
  • Yu Chen
    • 5
  • Soek-Siam Tan
    • 6
  • Tao Han
    • 7
  • Jinhua Hu
    • 8
  • Saeed S. Hamid
    • 9
  • Lee Guan Huei
    • 10
  • Hasmik Ghazinian
    • 11
  • Yuemin Nan
    • 12
  • Yogesh K. Chawla
    • 13
  • Man-Fung Yuen
    • 14
  • Harshad Devarbhavi
    • 15
  • Akash Shukla
    • 16
  • Zaigham Abbas
    • 17
  • Manoj Sahu
    • 18
  • A. K. Dokmeci
    • 19
  • Laurentias A. Lesmana
    • 20
  • Cosmas Rinaldi A. Lesmana
    • 20
  • Shaojie Xin
    • 8
  • Zhongping Duan
    • 5
  • Wei Guo
    • 1
  • Ke Ma
    • 1
  • Zhongwei Zhang
    • 1
  • Qiuyu Cheng
    • 1
  • Jidong Jia
    • 21
  • B. C. Sharma
    • 22
  • Shiv Kumar Sarin
    • 2
    Email author
  • Qin Ning
    • 1
    Email author
  1. 1.Department of Infectious Disease, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China
  2. 2.Departments of Hepatology and TransplantInstitute of Liver and Biliary SciencesNew DelhiIndia
  3. 3.Department of HepatologyBangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
  4. 4.State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina
  5. 5.Youan HospitalCapital Medical UniversityBeijingChina
  6. 6.Department of HepatologySelayang HospitalBatu CavesMalaysia
  7. 7.Department of GastroenterologyThird Central HospitalTianjingChina
  8. 8.Liver Failure Treatment and Research Centerthe Fifth Medical Center, Chinese PLA General HospitalBeijingChina
  9. 9.Department of MedicineAga Khan University HospitalKarachiPakistan
  10. 10.National University of Singapore and National University HospitalSingaporeSingapore
  11. 11.Department of HepatologyNork Clinical Hospital of Infectious DiseasesYerevanArmenia
  12. 12.Department of HepatologyHebei Medical UniversityShijiazhuangChina
  13. 13.Department of HepatologyPost Graduate Institute of Medical Education and ResearchChandigarhIndia
  14. 14.Department of MedicineQueen Mary HospitalHong KongChina
  15. 15.Department of Gastroenterology and HepatologySt John Medical CollegeBangaloreIndia
  16. 16.Department of HepatologyKEM HospitalMumbaiIndia
  17. 17.Department of HepatogastroenterologyZiauddin UniversityKarachiPakistan
  18. 18.Department of Gastroenterology and HepatologyIMS and SUM HospitalOdisaIndia
  19. 19.Department of GastroenterologyAnkara University School of MedicineAnkaraTurkey
  20. 20.Medistra HospitalDigestive Disease and GI Oncology CenterJakartaIndonesia
  21. 21.Liver Research Center, Beijing Friendship HospitalBeijingChina
  22. 22.Department of HepatologyInstitute of Liver and Biliary SciencesNew DelhiIndia

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