Abstract
AimTo determine the prognostic risk factors of patients with hepatitis B virus related acute‐on‐chronic liver failure (HBV‐ACLF) treated with plasma exchange (PE)‐based artificial liver support system (ALSS), and create a prognostic predictive model.MethodsA total of 304 HBV‐ACLF patients who received PE‐based ALSS were retrospectively analyzed. Potential prognostic factors on admission associated with survival were investigated. Of note, 101 additional patients were analyzed to validate the performance of the prognostic models.ResultsAccording to 28‐day survival, a total of 207 patients who survived and 97 non‐survivors were identified in the derivation group. Overall, 268 (88.2%) ACLF cases were caused by reactivation of HBV. Cox proportional hazards regression model revealed that age, total bilirubin, ln (alpha‐fetoprotein [AFP]), encephalopathy (HE) score, sodium level, and international normalized ratio (INR) were independent risk factors of short‐term prognosis. We built a model named ALSS‐prognosis model (APM) to predict the 28‐day survival of HBV‐ACLF patients with ALSS; the model APM showed potentially better predictive performance for both the derivation and validation groups than MELD, MELD‐Na, and CLIF‐C ACLF score.ConclusionsLow AFP was found to be an independent risk factor for high mortality in HBV‐ACLF patients treated with PE‐based ALSS. We generated a new model containing AFP, namely APM, which showed potentially better prediction performance than MELD, MELD‐Na, and CLIF‐C ACLF score for short‐term outcomes, and could aid physicians in making optimal therapeutic decisions.
Highlights
With an estimated 130 million carriers and 30 million chronically infected individuals, China has been recognized as a high-prevalence area for hepatitis B virus (HBV).[1]
HBV-ACLF, HBV related acute-onchronic liver failure; ALSS, artificial liver support system; PE, plasma exchange; Liver transplantation (LT), liver transplantation who met the diagnostic criteria for ACLF were included in the study (Figure 1)
Patients in the survivor group were significantly younger, had significantly less incidence of hepatic encephalopathy (HE) (P < .0001), had substantially lower levels of total bilirubin (TB) (P < .001), international normalized ratio (INR) (P < .001), D-dimer (P < .001), ferritin (P = .015) and white blood cell (WBC) counts (P < .001), as well as lower Model for End-stage Liver Disease (MELD), MELD-Na, Chronic Liver Failure-Consortium (CLIF-C) ACLF and COSSH-ACLF scores, but had higher AFP levels (P < .001) at admission compared to HBV-ACLF patients who did not survive
Summary
With an estimated 130 million carriers and 30 million chronically infected individuals, China has been recognized as a high-prevalence area for hepatitis B virus (HBV).[1]. Individuals with chronic HBV are at risk of developing an acute exacerbation leading to acute-onchronic liver failure (ACLF), which has high short-term mortality.[2]. Liver transplantation (LT) has been associated with long-term survival in these patients. A variety of artificial liver support systems (ALSSs) have been utilized to treat liver failure. Several studies have shown that ALSSs, in particular plasma exchange (PE), prolong the survival of patients with both ALF and ACLF.[3-5]. In addition to rapid elimination of toxic metabolites, PE is able to replenish beneficial plasma factors, which serves as a bridge to LT by providing a suitable environment for liver recovery.[6]
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