Study on characteristics and prognosis of organ failure in patients with hepatitis B virus-associated acute-on-chronic liver failure
10.3760/cma.j.issn.1007-3418.2018.10.002
- VernacularTitle: 乙型肝炎病毒相关慢加急性肝衰竭患者器官功能衰竭的特点与预后
- Author:
Juan WU
1
;
Lin JIA
1
;
Yuanyuan LI
2
;
Juan LI
1
;
Hongwei YU
1
;
Yueke ZHU
1
;
Zhongjie HU
1
;
Qinghua MENG
1
;
Fusheng WANG
2
Author Information
1. Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
2. 302 Military Hospital of China, Beijing 100039, China
- Publication Type:Journal Article
- Keywords:
Acute-on-chronic liver failure;
Hepatitis B virus;
CLIF-SOFA
- From:
Chinese Journal of Hepatology
2018;26(10):737-743
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the incidence, and the characteristics of organ failure in relationship to prognosis in hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) patients using chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score for judgments of clinical treatment and prognosis.
Methods:Clinical data of 316 patients who were diagnosed as HBV-ACLF during hospitalization from February 2015 to February 2016 were retrospectively analyzed. Intrahepatic and extrahepatic organ failures were assessed according to CLIF-SOFA score, and the relationship between clinical characteristics and prognosis was analyzed. Continuity variables were analyzed by analysis of variance, or Kruskal-Wallis H test. Comparison of the categorical data were done using χ 2 or Fisher's exact test, and the predictive efficacy of various prognostic scores was compared using the area under the receiver operating characteristic curve (AUROC) and Z-test.
Results:Of 316 cases (87.3% men) of HBV-ACLF, the mean age was (45 ± 11) years old. 78.8% of patients with underlying liver disease had hepatitis B virus induced cirrhosis. Mortality rates in patients without liver transplantation at 28 days, 90 days and 180 days were 20.5% (63/307), 36.7% (110/300) and 39.2% (116/296), respectively. According to the CLIF-SOFA score, 89.9% (284 patients) had organ failure at baseline, of which 97.5% had liver failure (Total bilirubin ≥ 12 mg/dl) and only 2.5% had coagulation, kidney, circulation or respiratory failure without liver failure. Besides liver failure, the incidence of extrahepatic organ failure was coagulation (23.1%), kidney (5.7%), brain (3.8%), circulation (1.3%) and respiratory failure (0.3%). With increasing number of organ failure, the mortality rate of two and three or more organ failures were 69.6% and 69.2%, respectively, which was significantly higher than that of single organ failure and non-organ failure patients (27% and 6.9%, respectively; P < 0.001). Liver failure with coagulation failure (International normalized ratio≥2.5 or platelet count≤20×109/L) had worst prognosis with a mortality rate of up to 75% at 90 days.
Conclusion:According to the CLIF-SOFA score, the main organ failure in patients with HBV-ACLF in China is liver failure. The mortality rate in patients with two or more organ failures is as high as 70% within 3 months. Therefore, timely manner liver transplantation should be considered.
