Analysis of Prognostic Factors for Short-term Outcome in Patients with Hepatitis B Virus-related Acute-on-chronic Liver Failure Treated with Artificial Liver_West China Medical Journal

Authors：

 WangMing , ChenFang , XieYan ,  TangHong

Infectious Disease Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

TangHong, Email: htang6198@hotmail.com

Keywords：

Acute-on-chronic liver failure; Artificial liver support system; Outcome; Logistic regression analysis

DOI：

10.7507/1002-0179.201600414

Video：

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Objective To learn the outcomes of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) cases after artificial liver support system (ALSS) treatment and the relevant factors correlated with the clinical outcomes. Methods In the period from January 2011 to June 2014, 321 patients with HBV-ACLF were admitted to West China Hospital. The clinical data at baseline, before and after treatment were analyzed by univariate and multivariate logistic regressions to identify the independent risk factors correlated with 30-day outcomes. Results Of all the 321 patients, 233 survived and 88 died by the end of a 30-day observation. The univariate analysis identified that the incidences of cirrhosis, hepatorenal syndrome and peritonitis in the death group were significantly higher (P<0.05). The model for end-stage liver disease values, white blood cells (WBC), blood ammonia, creatinine and total bilirubin (TBIL) at different stages in the death group were significantly higher than those in the survival group (P<0.05). In the death group, the HBV-DNA, TBIL decrease after triple ALSS treatments, baseline prothrombin time activity (PTA) and PTA level after triple ALSS treatments were significantly lower (P<0.05). The multivariate logistic regression indicated that WBC (OR=2.337, P<0.001) and TBIL level after triple ALSS treatments (OR=4.935, P<0.001) were independent predicting factors for death within 30 days after ALSS treatment; HBV-DNA (OR=0.403, P<0.001), the decrease of TBIL after triple ALSS treatments (OR=0.447, P<0.001) and PTA level after triple ALSS treatments (OR=0.332, P<0.001) were protecting factors for the 30-day prognosis. Conclusion These five factors including WBC, HBV-DNA, PTA, TBIL and TBIL decrease after triple ALSS treatments influence the short-term prognosis for HBV-ACLF patients, which are valuable for decision making in clinical practices.

Citation： WangMing, ChenFang, XieYan, TangHong. Analysis of Prognostic Factors for Short-term Outcome in Patients with Hepatitis B Virus-related Acute-on-chronic Liver Failure Treated with Artificial Liver. West China Medical Journal, 2016, 31(9): 1516-1520. doi: 10.7507/1002-0179.201600414 Copy

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1. 王貴強, 王福生, 成軍, 等. 慢性乙型肝炎防治指南(2015年更新版)[J]. 臨床肝膽病雜志, 2015, 31(12):1941-1960.
2. 劉曉燕, 胡瑾華, 王慧芬, 等. 1977例急性、亞急性、慢加急性肝衰竭患者的病因與轉歸分析[J]. 中華肝臟病雜志, 2008, 16(10):772-775.
3. Shen Y, Wang XL, Wang B, et al. Survival benefits with artificial liver support system for acute-on-chronic liver failure:a time series-based meta-analysis[J]. Medicine, 2016, 95(3):1-9.
4. 楊永峰, 魏林玲, 張寧, 等. 國內人工肝支持系統治療重型肝炎療效的Meta分析[J]. 中華肝臟病雜志, 2006, 14(10):732-734.
5. 張晶, 段鐘平, 何金秋, 等. 人工肝治療對重型肝病患者生存期的影響[J]. 中華肝臟病雜志, 2006, 14(9):647-651.
6. 中華醫學會感染病學分會肝衰竭與人工肝學組, 中華醫學會肝病學分會重型肝病與人工肝學組. 肝衰竭診治指南(2012年版)[J]. 中華臨床感染病雜志, 2012, 5(6):321-327.
7. 王學浩, 李國強. 我國肝移植現狀與面臨的挑戰[J]. 中華消化外科雜志, 2013, 12(9):641-643.
8. 蔣文濤, 王洪海, 郭慶軍. 成人活體肝移植的現狀[J]. 臨床肝膽病雜志, 2015, 31(12):2023-2026.
9. 姜楠, 王建鋒, 韓煒, 等. 人工肝支持系統的現狀和發展[J]. 中華消化外科雜志, 2013, 12(8):637-640.
10. 王英杰. 人工肝在肝衰竭中的應用與評價[J]. 實用肝臟病雜志, 2013, 16(1):20-21.
11. 崔燕平, 劉鳳華, 石慶鳳, 等. 106例慢加急性肝衰竭合并肝性腦病患者預后影響因素的Logistic回歸分析[J]. 臨床肝膽病雜志, 2014, 30(10):992-995.
12. 譚淑燕, 江元森, 麥峻婷, 等. 人工肝治療慢性乙型重型肝炎預后影響因素Logistic回歸分析[J]. 廣東醫學, 2006, 27(7):979-980.
13. 葉佩燕, 楊宗國, 陳曉蓉, 等. HBV相關慢加急性肝衰竭不同分期的預后評價及影響因素分析[J]. 臨床肝膽病雜志, 2013, 29(4):270-275.
14. 田方圓, 單靜, 唐寬銀, 等. 乙型肝炎相關性肝衰竭患者HBV DNA低水平復制及特異性抗體表達的臨床意義[J]. 臨床肝膽病雜志, 2014, 30(6):527-530.
15. 陳智. 肝衰竭發生與發展過程中的免疫機制研究進展[J]. 中華肝臟病雜志, 2012, 20(10):733-736.
16. dos Santos DC, Neves PC, Azeredo EL, et al. Activated lymphocytes and high liver expression of IFN-γ are associated with fulminant hepatic failure in patients[J]. Liver Int, 2012, 32(1):147-157.
17. Farci P, Diaz G, Chen Z, et al. B cell gene signature with massive intrahepatic production of antibodies to hepatitis B core antigen in hepatitis B virus-associated acute liver failure[J]. Proc Natl Acad Sci USA, 2010, 107(19):8766-8771.

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Analysis of Prognostic Factors for Short-term Outcome in Patients with Hepatitis B Virus-related Acute-on-chronic Liver Failure Treated with Artificial Liver

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