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Prognosis, Prevention and Research Prospects of Progression to Severe Hepatitis B (Liver Failure)

  • Yu-Ming Wang
  • Dao-Feng Yang
  • Ming Wang
  • Nazia Selzner
  • Kaveh Farrokhi
  • Andrzej Chruscinski
  • Gary Levy
Chapter

Abstract

This chapter describes the factors involved in the disease prognosis, parameters of outcome evaluations, principles and techniques for progression prevention. In last section, the future perspectives in both basic and clinical investigations towards unmet medical needs in AECHB and HBV ACLF are discussed.
  1. 1.

    Factors affecting the prognosis of patients with severe hepatitis B include those related to the virus (including viral load, HBeAg expression, and gene mutation), patient age, co-morbidity, TBil, INR, serum Cr, and the host genetic background. Indicators associated with patient prognosis include TBil, total cholesterol, albumin and prealbumin, hepatic encephalopathy, kidney damage, alpha-fetoprotein and vitamin D binding protein, blood sodium level, virus HBeAg expression and genotype, and blood glucose.

     
  2. 2.

    In addition to TBil, INR, hepatic encephalopathy, Cr level and AFP as indicators for prognosis of severe hepatitis, some other parameters such as clinical signs, symptoms, serum levels of total cholesterol and albumin and natrium, and coagulation factors are all valuable in assessment. The roles of cell apoptosis, liver regeneration and immunological parameters in assessing patient prognosis are under study. Prognostic evaluating systems include MELD score, MELD-Na score, iMELD score, KCI and CTP score.

     
  3. 3.

    Prevention of severe hepatitis B should be started in asymptomatic patients. Close observation, sufficient rest, adequate nutrition, meticulous nursing and psychological care, preventing and removing exacerbating factors, treating concomitant diseases, reasonable antiviral and comprehensive therapies are helpful to prevent CHB patients from developing to severe hepatitis. For patients who already have severe hepatitis B, the prevention and management of complications is important for lowering mortality rate.

     
  4. 4.

    New research directions in acute-on-chronic liver failure include: (1) Additional well controlled studies using present or new liver systems are warranted. Other approaches include the use of granulocyte colony stimulating factor to treat infections as well as the potential of use of stem cells to restore immune integrity and enhance liver regeneration. (2) Using new cell lines and animal models to understand the molecular biology of HBV, the immune response and to develop novel therapies. (3) Development of new anti-HBV strategies, e.g. silencing or remove cccDNA, enhancing immunologic clearance of HBV infection, inhibiting virus entry or HBc expression and using CRISP to disrupt cccDNA.

     

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Copyright information

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

Authors and Affiliations

  • Yu-Ming Wang
    • 1
  • Dao-Feng Yang
    • 2
  • Ming Wang
    • 2
  • Nazia Selzner
    • 3
  • Kaveh Farrokhi
    • 3
  • Andrzej Chruscinski
    • 3
  • Gary Levy
    • 3
  1. 1.Southwest Hospital, The First Hospital Affiliated to AMUChongqingChina
  2. 2.Tongji Hospital of Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
  3. 3.Multi Organ Transplant ProgramUniversity Health Network, University of Toronto Transplant InstituteTorontoCanada

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