An analysis of the characteristics and the prognostic impact factors of liver failure caused by drug withdrawal in chronic hepatitis B patients

Abstract

Abstract: Objective To investigate the characteristics of liver failure caused by discontinuation of antiviral drugs in chronic hepatitis B (CHB) patients and analysis the impact factors affecting prognosis.Methods One hundred and six chronic hepatitis B patients who were admitted to Shiyan People's Hospital from January 2015 to January 2020 were enrolled in this study. They were all suffered from liver failure due to withdrawal of anti-viral drugs. Based on their survival situation at the 12th week, they were divided into survival group (N=47 cases) and death group (N=59 cases). The baseline data, treatment plan, biochemical indicators, viral load and other clinical data of both groups of patients were collected. The clinical characteristics of these two groups of patients were compared and analyzed for the impact factors affecting prognosis. T-test was used to compare the measurement data of the normal distribution; Mann-Whitney U test was used to compare the measurement data of the skewed distribution; χ² test was used to compare the counting data; Logistic regression was used to analyze the impact factors affecting prognosis.Results The incidence of cirrhosis in the death group was 88.14% (52/59), which was significantly higher than that of 18.75% (9/48) in the survival group (P<0.05). The levels of albumin, γ-transglutaminase and cholinesterase in the survival group were significantly higher than those in the death group. The total bilirubin, prothrombin time, international normalized ratio, and model for end-stage liver disease (MELD) score in the survival group were significantly lower than those in the death group (P<0.05). The grades of acute-on-chronic liver failure (ACLF) classification between these two groups were significantly different (P<0.05). Logistic regression was used to analyze the impact factors affecting prognosis. The result indicated that higher ACLF grades and liver cirrhosis are independent predictors of poor prognosis.Conclusion CHB patients with liver cirrhosis have a higher risk of liver failure after discontinuation of anti-viral drugs. The patients have a higher mortality rate once progress to liver failure. Meanwhile, the clinical outcome of the CHB patients with liver failure due to discontinuation of anti-viral drugs is associated with the severity grade of ACLF classification and whether the patient has cirrhosis.

Key words: Chronic hepatitis B, Withdrawal of antiviral therapy, Liver failure, Prognosis

DUAN Xing-gang, LIU Li, LIU Liang-ting, WANG Ying-tian, FAN Qun-xiong. An analysis of the characteristics and the prognostic impact factors of liver failure caused by drug withdrawal in chronic hepatitis B patients[J]. Chinese Hepatolgy, 2021, 26(6): 617-620.

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