Modified model for end-stage liver disease improves short-term prognosis of hepatitis B virus-related acute-on-chronic liver failure

Scoring models and test indexes for diagnosis and prognosis of hepatitis B virus-related acute-on-chronic liver failure

Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is a common type of liver failure, which can occur in the context of chronic hepatitis B or cirrhosis compensatory period or decompensated period. HBV-ACLF progresses rapidly, is often complicated with multiple organ failure syndrome involving the liver, brain, heart, kidney, etc., and is associated with an extremely high short-term mortality rate. The American College of Gastroenterology (ACG) defines HBV-ACLF as a potentially reversible disease, and early diagnosis and standardized treatment will affect its prognosis. In recent years, the clinical application of some new scoring models and biomarkers has effectively improved the diagnosis and prognosis of HBV-ACLF. This article reviews some scoring models and test indexes recently used in the clinical treatment and explores their value in the diagnosis and prognosis of HBV-ACLF.

Artificial liver support systems for hepatitis B virus-associated acute-on-chronic liver failure: A meta-analysis of the clinical literature

To evaluate the short-term and long-term survival efficacy of an artificial liver support system (ALSS) in patients with acute-on-chronic liver failure (ACLF). A systematic search was performed for relevant published data in PubMed, Web of Science and Cochrane Library databases. Studies that evaluated the efficacy of ALSS in patients with ACLF and provided the short-term or long-term survival rate were included. A total of 10 studies involving 3685 patients were included in this analysis. The pooled 28-day survival rate and 90-day survival rate were 68.7% (95% CI: 64.5%-72.9%) and 53.4% (95% CI: 45.5%-61.4%), respectively. The pooled estimates of the OR for the 28-day and 90-day survival rates between the ALSS group and the control group were 1.91 (95% CI: 1.21-3.04) and 1.41 (95% CI: 1.17-1.70), respectively. Subgroup analysis showed that patients treated with lower levels of TBIL and MELD scores had a higher 28-day survival rate (χ²  = 15.75, p < 0.01; χ²  = 13.80, p < 0.01). The present meta-analysis suggests that ALSS treatment could remarkably improve short-term survival rates in HBV-ACLF patients, which implies that treatment with ALSS may help to reduce high mortality. Further prospective randomized trials are needed to validate these findings.

Low high-density lipoprotein cholesterol levels predicting poor outcomes in patients with hepatitis B virus-related acute-on-chronic liver failure

Background

Lipid profile disorders frequently occur in patients with advanced liver diseases. High-density lipoprotein cholesterol (HDL-C) levels decrease rapidly during acute conditions of some diseases, and HDL-C levels may be related to mortality in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).

Materials and methods

A retrospective cohort study was conducted on 200 subjects with HBV-ACLF. The patients were separated into non-survivors and survivors according to their 28-day outcome. Univariate and multivariate Cox regression analyses were performed to identify predictors of mortality, and the performance of these predictors was evaluated by receiver operating characteristic (ROC) curve analysis. Kaplan-Meier analysis was performed to draw survival curves of HDL-C.

Results

The 28-day mortality in the cohort was 27.0%. HDL-C levels differed markedly between non-survivors and survivors. In the multivariate analysis, HDL-C, the Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), and Chinese Group on the Study of Severe Hepatitis B-ACLF II (COSSH-ACLF II) scores were identified as independent predictors for mortality (HR = 0.806, 95% CI: 0.724-0.898; HR = 1.424, 95% CI: 1.143-1.775; HR = 1.006, 95% CI: 1.002-1.007; and HR = 1.609, 95% CI: 1.005-2.575, respectively). Patients with lower HDL-C levels had a worse prognosis than those with higher HDL-C levels. In ROC analysis, the prognostic accuracy for mortality was similar between HDL-C (AUROC: 0.733) and the CTP, MELD, and COSSH-ACLF II scores (AUROC: 0.753; 0.674 and 0.770, respectively).

Conclusion

The HDL-C level may serve as a potential indicator for the prognosis of HBV-ACLF and can be used as a simple marker for risk assessment and selection of therapeutic options.

Comparison of five different scoring models for predicting short-term mortality in patients with alcohol-related acute-on-chronic liver failure

AIM

To compare the performance of age, bilirubin, INR, and creatinine (ABIC), Maddrey's discriminant function (MDF), model for end-stage liver disease (MELD), chronic liver failure-sequential organ failure assessment (CLIF-SOFA), and Child-Turcotte-Pugh (CTP) in predicting short-term mortality in patients with alcohol-related acute-on-chronic liver failure (ACLF).

METHODS

There were 462 consecutive patients with live failure treated from August 2005 to June 2017 at Tianjin Third Central Hospital, of whom 152 with alcohol-related ACLF were finally enrolled in this study according to the inclusion criteria and exclusion criteria. We divided patients into either group A or group B. Patients in group A met the criteria of Asian Pacific Association for the Study of the Liver but did not met the criteria of European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF), and patients in group B met the criteria of EASL-CLIF on admission. The performance of different scoring models in predicting short-term mortality was assessed using the area under the receiver operating characteristic curve (AUC-ROC).

RESULTS

The 28-d mortality rate was 19% in group A and 50% in group B (P = 0.002). In group A, the AUC of CLIF-SOFA for predicting the 28-d mortality was highest (0.889), followed by MELD (0.761), MDF (0.738), ABIC (0.718), and CTP (0.671), and there was a significant difference between CTP and the others. In group B, the AUC of CLIF-SOFA was 0.916, followed by MELD (0.804), MDF (0.770), ABIC (0.729), and CTP (0.647), and there was a significant difference between CLIF-SOFA and the others and between CTP and the others.

CONCLUSION

The five scoring systems could all predict the short-term prognosis of the two groups of patients. However, CLIF-SOFA performs well compared to the others, regardless of patients in group A or group B.