Abstract
Background Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ALCF) is a complicated syndrome with extremely high short-term mortality. The artificial liver support system (ALSS) may improve the liver function for patients with HBV-ACLF, but the data on its short-term outcomes are insufficient in China. Methods We recruited HBV-ACLF patients in this nationwide, multicenter, retrospective study. Patients with HBV-ACLF were diagnosed by the COSSH-ACLF criteria. Propensity score matching (PSM) analysis was used to generate compared pairs. The short-term (28/90 days) survival rates between the standard medical therapy (SMT) group and ALSS group were calculated using a Kaplan–Meier graph. Result In total, 790 patients with HBV-ACLF were included in this retrospective study; 412 patients received SMT only (SMT group), and 378 patients received SMT and ALSS treatment (ALSS group). PSM generated 310 pairs and eliminated the baseline differences between the two groups (p > 0.05 for all baseline variables). The probabilities of survival on day 28 were 65.2% (205/310) in the ALSS group and 59.0% (185/310) in the SMT group; on day 90, they were 51.0% (163/310) and 42.3% (136/310). The short-term (28/90 days) survival rates of the ALSS group were significantly higher than those of the SMT group (p=0.0452 and p=0.0187, respectively). Compared to receiving SMT alone, treatment with ALSS was associated with a significant reduction in serum bilirubin levels and the model for end-stage liver disease (MELD) scores at day 7 and day 28. Multivariate logistic regression analysis revealed that older age, high total bilirubin (T-Bil), low albumin, high ALT, high MELD scores, and high COSSH-ACLF grade were independent baseline factors associated with poor prognosis. Conclusions This retrospective study found that compared to SMT, the ALSS improved the short-term (28/90 days) survival rates and laboratory parameters in HBV-ACLF patients. The ALSS had a better therapeutic effect than SMT for patients with HBV-ACLF in China.
Highlights
Chronic hepatitis B (CHB) is a major public health challenge in China, with an estimated 78 million chronic carriers and 28 million patients with active hepatitis [1]
CHB is a significant risk factor that accounts for nearly 45% of cases of hepatocellular carcinoma (HCC) and 30% of cases of cirrhosis, causing nearly 1 million deaths each year worldwide [2, 3]. e high prevalence of CHB causes that hepatitis B virus (HBV) infection absolutely predominated in the etiologies of ACLF, accounting for 96.5% cases in China, while alcoholism is the most common etiologies of ACLF in western developed countries [4, 5]
Inclusion and Exclusion Criteria. e inclusion criteria were as follows: Patients diagnosed with CHB [19] (HBV surface antigenpositive ≥6 months; serum HBV-DNA ≥20 000 IU/mL; a liver biopsy showing chronic hepatitis) and reached at least ACLF grade 1 diagnosed by the COSSH-ACLF criteria [6]: (1) ACLF grade 1: patients with kidney failure alone; patients with single liver failure with an international normalized ratio (INR) ≥1.5 and/or kidney dysfunction and/or hepatic encephalopathy (HE) grade I or II; patients with single type of organ failure of the coagulation, circulatory, or respiratory systems and/or kidney dysfunction and/or HE grade I or II; and patients with cerebral failure alone plus kidney dysfunction
Summary
Chronic hepatitis B (CHB) is a major public health challenge in China, with an estimated 78 million chronic carriers and 28 million patients with active hepatitis [1]. A single-center study conducted in China reported that ALSS improved 90 days and 5 years outcomes of patients with HBV-ACLF [18]. Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ALCF) is a complicated syndrome with extremely high short-term mortality. E artificial liver support system (ALSS) may improve the liver function for patients with HBV-ACLF, but the data on its short-term outcomes are insufficient in China. Compared to receiving SMT alone, treatment with ALSS was associated with a significant reduction in serum bilirubin levels and the model for end-stage liver disease (MELD) scores at day 7 and day 28. Is retrospective study found that compared to SMT, the ALSS improved the short-term (28/90 days) survival rates and laboratory parameters in HBV-ACLF patients. Conclusions. is retrospective study found that compared to SMT, the ALSS improved the short-term (28/90 days) survival rates and laboratory parameters in HBV-ACLF patients. e ALSS had a better therapeutic effect than SMT for patients with HBV-ACLF in China
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