Discussion and evaluation of diagnostic criteria for hepatitis B virus-related acute-on-chronic pre-liver failure
10.3760/cma.j.issn.1007-3418.2018.02.011
- VernacularTitle: 乙型肝炎病毒相关慢加急性肝衰竭前期患者诊断标准的探讨
- Author:
Chen LI
1
;
Bing ZHU
;
Sa LYU
;
Shaoli YOU
Author Information
1. Liver Failure Treatment and Research Centre, 302 Military Hospital, Beijing 100039, China
- Publication Type:Journal Article
- Keywords:
Hepatitis B virus;
Liver failure;
Pre-;
Diagnostic criteria
- From:
Chinese Journal of Hepatology
2018;26(2):130-135
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the concept of hepatitis B virus (HBV)-related acute-on-chronic pre-liver failure (pre-ACLF), and to develop and evaluate the diagnostic criteria for this disease.
Methods:A retrospective analysis was performed for the clinical data of 754 patients with severe acute exacerbation (SAE) of HBV-related chronic liver disease, and their clinical features were identified. A multivariate logistic regression analysis was used to determine the risk factors for acute-on-chronic liver failure (ACLF). The inclusion rate of patients with SAE-HBV-related chronic liver disease and the detection rate of ACLF patients were analyzed to evaluate the value of four different versions of diagnostic criteria for pre-liver failure. The t-test, an analysis of variance, the Mann-Whitney U test, and the chi-square test were used for statistical analysis based on data type.
Results:The incidence rate of ACLF in the patients with SAE-HBV-related chronic liver disease was 9.9% and the time to progression to ACLF was 12.0 ± 6.7 days. The multivariate logistic regression analysis showed that HBV reactivation (odds ratio [OR] = 5.118), direct bilirubin ratio (D/T) (OR = 1.041), age (OR = 1.033), total bilirubin (TBil) (OR = 1.005), prothrombin activity (PTA) (OR = 0.880), and serum sodium (Na) (OR = 0.918) were independent risk factors for ACLF. Group B (51.3 μmol/L < TBil < 171.1 μmol/L and 40%≤PTA < 60%, 4.2%) had a significantly lower incidence rate of ACLF than group A (51.3 μmol/L < TBil < 171.1 μmol/L and PTA < 40%, 13.7%) and group C (TBil > 171.1 μmol/L and 40% < PTA < 60%, 20.3%) (P < 0.001). Group C had a significantly shorter time to progression to ACLF than group A (10.5 ± 6.1 days vs 15.6 ± 7.4 days, P = 0.008). A total of 45 patients met the diagnostic criteria developed by Chongqing and the incidence rate of ACLF was 2.2%; 154 patients met the diagnostic criteria developed by Zhejiang and the incidence rate of ACLF was 7.1%; 188 patients met the diagnostic criteria in the Chinese guidelines and the incidence rate of ACLF was 6.4%; 117 patients met the diagnostic criteria for SAE-CHB and the incidence rate of ACLF was 9.4%.
Conclusion:At present, these four versions of diagnostic criteria for pre-liver failure are not fully applicable to the clinical practice in China. The diagnostic criteria for HBV-related pre-ACLF should include important assessment indices which affect its progression to ACLF.
