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Article: Complications constitute a major risk factor for mortality in hepatitis B virus-related acute-on-chronic liver failure patients: a multi-national study from the Asia–Pacific region

TitleComplications constitute a major risk factor for mortality in hepatitis B virus-related acute-on-chronic liver failure patients: a multi-national study from the Asia–Pacific region
Authors
KeywordsHBV
HBV
Acute-on-chronic liver failure
Cirrhosis
Prognostic scores
Issue Date2019
PublisherSpringer (India) Private Ltd. The Journal's web site is located at http://www.springer.com/medicine/internal/journal/12072
Citation
Hepatology International, 2019, v. 13, p. 695-705 How to Cite?
AbstractBackground and Aim: Cirrhosis is a controversial determinant of mortality in HBV-related acute-on-chronic liver failure (HBV–ACLF). The present study aimed to explore the effects of cirrhosis and the associated risk factors, especially its complications, on the outcome of HBV–ACLF. Methods: A prospective–retrospective cohort of 985 patients was identified from the APASL–ACLF Research Consortium (AARC) database and the Chinese Study Group. Complications of ACLF (ascites, infection, hepatorenal syndrome, hepatic encephalopathy, upper gastrointestinal bleeding) as well as cirrhosis and the current main prognostic models were measured for their predictive ability for 28- or 90-day mortality. Results: A total of 709 patients with HBV–ACLF as defined by the AARC criteria were enrolled. Among these HBV–ACLF patients, the cirrhotic group showed significantly higher mortality and complications than the non-cirrhotic group. A total of 36.1% and 40.1% of patients met the European Association for the Study of Liver (EASL)–Chronic Liver Failure consortium (CLIF-C) criteria in the non-cirrhotic and cirrhotic groups, respectively; these patients had significantly higher rates of mortality and complications than those who did not satisfy the CLIF-C criteria. Furthermore, among patients who did not meet the CLIF-C criteria, the cirrhotic group exhibited higher mortality and complication rates than the non-cirrhotic group, without significant differences in organ failure. The Tongji prognostic predictor model score (TPPMs), which set the number of complications as one of the determinants, showed comparable or superior ability to the Chinese Group on the Study of Severe Hepatitis B–ACLF score (COSSH–ACLFs), APASL–ACLF Research Consortium score (AARC–ACLFs), CLIF-C organ failure score (CLIF–C OFs), CLIF-C–ACLF score (CLIF-C–ACLFs), Model for End-Stage Liver Disease score (MELDs) and MELD–sodium score (MELD–Nas) in HBV–ACLF patients, especially in cirrhotic HBV-–ACLF patients. Patients with two (OR 4.70, 1.88) or three (OR 8.27, 2.65) complications had a significantly higher risk of 28- or 90-day mortality, respectively. Conclusion: The presence of complications is a major risk factor for mortality in HBV–ACLF patients. TPPM possesses high predictive ability in HBV–ACLF patients, especially in cirrhotic HBV–ACLF patients.
Persistent Identifierhttp://hdl.handle.net/10722/284579
ISSN
2019 Impact Factor: 5.102
2015 SCImago Journal Rankings: 0.669

 

DC FieldValueLanguage
dc.contributor.authorChen, T-
dc.contributor.authorYang, Z-
dc.contributor.authorChoudhury, AK-
dc.contributor.authorAl Mahtab, M-
dc.contributor.authorLi, J-
dc.contributor.authorChen, Y-
dc.contributor.authorTan, SS-
dc.contributor.authorHan, T-
dc.contributor.authorHu, J-
dc.contributor.authorHamid, SS-
dc.contributor.authorHue, LG-
dc.contributor.authorGhazinian, H-
dc.contributor.authorNan, YM-
dc.contributor.authorChawla, YK-
dc.contributor.authorYuen, MF-
dc.contributor.authorDevarbhavi, H-
dc.contributor.authorShukla, A-
dc.contributor.authorAbbas, Z-
dc.contributor.authorSahu, M-
dc.contributor.authorDokmeci, AK-
dc.contributor.authorLesmana, LA-
dc.contributor.authorLesmana, CRA-
dc.contributor.authorXin, S-
dc.contributor.authorDuan, Z-
dc.contributor.authorGuo, W-
dc.contributor.authorMa, K-
dc.contributor.authorZhang, Z-
dc.contributor.authorCheng, Q-
dc.contributor.authorJia, J-
dc.contributor.authorSharma, BC-
dc.contributor.authorSarin, SK-
dc.contributor.authorNing, Q-
dc.date.accessioned2020-08-07T08:59:39Z-
dc.date.available2020-08-07T08:59:39Z-
dc.date.issued2019-
dc.identifier.citationHepatology International, 2019, v. 13, p. 695-705-
dc.identifier.issn1936-0533-
dc.identifier.urihttp://hdl.handle.net/10722/284579-
dc.description.abstractBackground and Aim: Cirrhosis is a controversial determinant of mortality in HBV-related acute-on-chronic liver failure (HBV–ACLF). The present study aimed to explore the effects of cirrhosis and the associated risk factors, especially its complications, on the outcome of HBV–ACLF. Methods: A prospective–retrospective cohort of 985 patients was identified from the APASL–ACLF Research Consortium (AARC) database and the Chinese Study Group. Complications of ACLF (ascites, infection, hepatorenal syndrome, hepatic encephalopathy, upper gastrointestinal bleeding) as well as cirrhosis and the current main prognostic models were measured for their predictive ability for 28- or 90-day mortality. Results: A total of 709 patients with HBV–ACLF as defined by the AARC criteria were enrolled. Among these HBV–ACLF patients, the cirrhotic group showed significantly higher mortality and complications than the non-cirrhotic group. A total of 36.1% and 40.1% of patients met the European Association for the Study of Liver (EASL)–Chronic Liver Failure consortium (CLIF-C) criteria in the non-cirrhotic and cirrhotic groups, respectively; these patients had significantly higher rates of mortality and complications than those who did not satisfy the CLIF-C criteria. Furthermore, among patients who did not meet the CLIF-C criteria, the cirrhotic group exhibited higher mortality and complication rates than the non-cirrhotic group, without significant differences in organ failure. The Tongji prognostic predictor model score (TPPMs), which set the number of complications as one of the determinants, showed comparable or superior ability to the Chinese Group on the Study of Severe Hepatitis B–ACLF score (COSSH–ACLFs), APASL–ACLF Research Consortium score (AARC–ACLFs), CLIF-C organ failure score (CLIF–C OFs), CLIF-C–ACLF score (CLIF-C–ACLFs), Model for End-Stage Liver Disease score (MELDs) and MELD–sodium score (MELD–Nas) in HBV–ACLF patients, especially in cirrhotic HBV-–ACLF patients. Patients with two (OR 4.70, 1.88) or three (OR 8.27, 2.65) complications had a significantly higher risk of 28- or 90-day mortality, respectively. Conclusion: The presence of complications is a major risk factor for mortality in HBV–ACLF patients. TPPM possesses high predictive ability in HBV–ACLF patients, especially in cirrhotic HBV–ACLF patients.-
dc.languageeng-
dc.publisherSpringer (India) Private Ltd. The Journal's web site is located at http://www.springer.com/medicine/internal/journal/12072-
dc.relation.ispartofHepatology International-
dc.rightsThis is a post-peer-review, pre-copyedit version of an article published in [insert journal title]. The final authenticated version is available online at: https://doi.org/[insert DOI]-
dc.subjectHBV-
dc.subjectHBV-
dc.subjectAcute-on-chronic liver failure-
dc.subjectCirrhosis-
dc.subjectPrognostic scores-
dc.titleComplications constitute a major risk factor for mortality in hepatitis B virus-related acute-on-chronic liver failure patients: a multi-national study from the Asia–Pacific region-
dc.typeArticle-
dc.identifier.emailYuen, MF: mfyuen@hku.hk-
dc.identifier.authorityYuen, MF=rp00479-
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1007/s12072-019-09992-x-
dc.identifier.pmid31650510-
dc.identifier.scopuseid_2-s2.0-85074578307-
dc.identifier.hkuros312448-
dc.identifier.volume13-
dc.identifier.spage695-
dc.identifier.epage705-
dc.publisher.placeIndia-

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