Clin Mol Hepatol.  2015 Sep;21(3):232-241. 10.3350/cmh.2015.21.3.232.

Static and dynamic prognostic factors for hepatitis-B-related acute-on-chronic liver failure

• Ha JM
• Sohn W
• Cho JY
• Pyo JH
• Choi K
• Sinn DH
• Gwak GY
• Choi MS
• Lee JH
• Koh KC
• Paik SW
• Yoo BC
• Paik YH

• KMID: 2351023
• DOI: http://doi.org/10.3350/cmh.2015.21.3.232

Abstract

BACKGROUND/AIMS
Hepatitis-B-related acute-on-chronic liver failure has a poor prognosis. However, the advent of potent oral antiviral agents means that some patients can now recover with medical treatment. We aimed to identify the prognostic factors for hepatitis-B-related acute-on-chronic liver failure including the initial as well as the dynamically changing clinical parameters during admission.
METHODS
Sixty-seven patients were retrospectively enrolled from 2003 to 2012 at Samsung Medical Center. The patients were classified into three categories: Recovery group (n=23), Liver transplantation group (n=28), and Death group (n=16). The Liver transplantation and Death groups were combined into an Unfavorable prognosis group. We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals.
RESULTS
A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (> or =28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (> or =grade III) (OR=15.41, P=0.013). Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P=0.016).
CONCLUSIONS
Dynamic changes in clinical parameters during admission are useful prognostic factors for hepatitis-B-related acute-on-chronic liver failure.

Keyword

Acute-on-chronic liver failure; Chronic hepatitis B; Model for End-Stage Liver Disease; Liver transplantation

MeSH Terms

Acute-On-Chronic Liver Failure/*diagnosis/drug therapy/etiology
Adult
Aged
Antibodies, Monoclonal, Murine-Derived/therapeutic use
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
Antiviral Agents/therapeutic use
Cyclophosphamide/therapeutic use
DNA, Viral/analysis
Doxorubicin/therapeutic use
Female
Hepatitis B virus/genetics
Hepatitis B, Chronic/complications/*diagnosis/drug therapy
Hospitalization
Humans
Liver Transplantation
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Prednisone/therapeutic use
Prognosis
Retrospective Studies
Severity of Illness Index
Vincristine/therapeutic use
Young Adult
Antibodies, Monoclonal, Murine-Derived
Antiviral Agents
Cyclophosphamide
Doxorubicin
DNA, Viral
Prednisone
Vincristine