Early Prognostic Predictive System of AECHB and the Diagnosis of Severe Hepatitis B (Liver Failure)

  • Zhi Chen
  • Qin Ning
  • Guang Chen


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. 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. 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. 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. 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. 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. 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.



  1. 1.
    Volk ML, Marrero JA. Advances in critical care hepatology. Minerva Anestesiol. 2006;72(5):269–81.PubMedGoogle Scholar
  2. 2.
    Han MK, Hyzy R. Advances in critical care management of hepatic failure and insufficiency. Crit Care Med. 2006;34(9 Suppl):S225–31.CrossRefGoogle Scholar
  3. 3.
    Wang Y, Changhai G. Liver failure. Beijing: People’s Medical Publishing House; 2002.Google Scholar
  4. 4.
    Rolando N, Philpott-Howard J, Williams R. Bacterial and fungal infection in acute liver failure. Semin Liver Dis. 1996;16(4):389–402.CrossRefGoogle Scholar
  5. 5.
    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.Google Scholar
  6. 6.
    Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for clinicians. CMAJ. 2005;172(3):367–79.CrossRefGoogle Scholar
  7. 7.
    Schiodt FV, Ostapowicz G, Murray N, et al. Alpha-fetoprotein and prognosis in acute liver failure. Liver Transpl. 2006;12(12):1776–81.CrossRefGoogle Scholar
  8. 8.
    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.Google Scholar
  9. 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.Google Scholar
  10. 10.
    Williams R. Classification, etiology, and considerations of outcome in acute liver failure. Semin Liver Dis. 1996;16(4):343–8.CrossRefGoogle Scholar
  11. 11.
    Trey C, Davidson CS. The management of fulminant hepatic failure. Prog Liver Dis. 1970;3:282–98.PubMedGoogle Scholar
  12. 12.
    Gimson AE, O’Grady J, Ede RJ, et al. Late onset hepatic failure: clinical, serological and histological features. Hepatology. 1986;6(2):288–94.CrossRefGoogle Scholar
  13. 13.
    O’Grady JG, Schalm SW, Williams R. Acute liver failure: redefining the syndromes. Lancet. 1993;342(8866):273–5.CrossRefGoogle Scholar
  14. 14.
    Polson J, Lee WM. AASLD position paper: the management of acute liver failure. Hepatology. 2005;41(5):1179–97.CrossRefGoogle Scholar
  15. 15.
    Jalan R, Williams R. Acute-on-chronic liver failure: pathophysiological basis of therapeutic options. Blood Purif. 2002;20(3):252–61.CrossRefGoogle Scholar
  16. 16.
    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.CrossRefGoogle Scholar
  17. 17.
    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.CrossRefGoogle Scholar
  18. 18.
    Wang X, Sarin SK, Ning Q. Definition of ACLF and inclusion criteria for extra-hepatic organ failure. Hepatol Int. 2015;9(3):360–5.CrossRefGoogle Scholar
  19. 19.
    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.CrossRefGoogle Scholar
  20. 20.
    Jalan R, Gines P, Olson JC, et al. Acute-on chronic liver failure. J Hepatol. 2012;57(6):1336–48.CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. and Huazhong University of Science and Technology Press 2019

Authors and Affiliations

  • Zhi Chen
    • 1
  • Qin Ning
    • 2
  • Guang Chen
    • 2
  1. 1.The First Affiliated HospitalZhejiang UniversityZhejiangChina
  2. 2.Tongji Hospital of Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina

Personalised recommendations