Static and dynamic prognostic factors for hepatitis-B-related acute-on-chronic liver failure.
10.3350/cmh.2015.21.3.232
- Author:
Jung Min HA
1
;
Won SOHN
;
Ju Yeon CHO
;
Jeung Hui PYO
;
Kyu CHOI
;
Dong Hyun SINN
;
Geum Youn GWAK
;
Moon Seok CHOI
;
Joon Hyeok LEE
;
Kwang Chul KOH
;
Seung Woon PAIK
;
Byung Chul YOO
;
Yong Han PAIK
Author Information
1. Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. yh.paik@skku.edu
- Publication Type:Original Article
- Keywords:
Acute-on-chronic liver failure;
Chronic hepatitis B;
Model for End-Stage Liver Disease;
Liver transplantation
- MeSH:
Acute-On-Chronic Liver Failure/*diagnosis/drug therapy/etiology;
Adult;
Aged;
Antibodies, Monoclonal, Murine-Derived/therapeutic use;
Antineoplastic Combined Chemotherapy Protocols/therapeutic use;
Antiviral Agents/therapeutic use;
Cyclophosphamide/therapeutic use;
DNA, Viral/analysis;
Doxorubicin/therapeutic use;
Female;
Hepatitis B virus/genetics;
Hepatitis B, Chronic/complications/*diagnosis/drug therapy;
Hospitalization;
Humans;
Liver Transplantation;
Male;
Middle Aged;
Multivariate Analysis;
Odds Ratio;
Prednisone/therapeutic use;
Prognosis;
Retrospective Studies;
Severity of Illness Index;
Vincristine/therapeutic use;
Young Adult
- From:Clinical and Molecular Hepatology
2015;21(3):232-241
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Hepatitis-B-related acute-on-chronic liver failure has a poor prognosis. However, the advent of potent oral antiviral agents means that some patients can now recover with medical treatment. We aimed to identify the prognostic factors for hepatitis-B-related acute-on-chronic liver failure including the initial as well as the dynamically changing clinical parameters during admission. METHODS: Sixty-seven patients were retrospectively enrolled from 2003 to 2012 at Samsung Medical Center. The patients were classified into three categories: Recovery group (n=23), Liver transplantation group (n=28), and Death group (n=16). The Liver transplantation and Death groups were combined into an Unfavorable prognosis group. We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals. RESULTS: A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (> or =28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (> or =grade III) (OR=15.41, P=0.013). Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P=0.016). CONCLUSIONS: Dynamic changes in clinical parameters during admission are useful prognostic factors for hepatitis-B-related acute-on-chronic liver failure.
