The clinical characteristics of HBV related acute on chronic liver failure patients with hepatitis B after withdrawal of nucleoside (acid) analogues

Abstract

Abstract: Objective To analyze the clinical characteristics of acute on chronic liver failure (ACLF) patients with hepatitis B after stopping anti-viral drugs, and to emphasize the awareness of standardized medication.Methods Forty ACLF patients with chronic hepatitis B (CHB) and CHB related liver cirrhosis (CHB-cirrhosis) who stopped taking oral nucleoside (acid) analogues were selected in this study. The association between the types of withdrawal drugs and the occurrence of ACLF, and the prognosis of these patients after active comprehensive treatment were analyzed.Results Among the types of withdrawal drugs resulting in ACLF, the proportion of entecavir was the highest (52.5%). In CHB group, the proportion of entecavir discontinuation associated ACLF was the highest (65.2%). In CHB- cirrhosis group, the proportion of adefovir dipivoxil withdrawal associated ACLF was the highest (41.2%). In 40 patients who had stopped taking anti-viral medicine, the levels of cholinesterase (CHE) (7 235±825.2 U/L) and α-fetoprotein (AFP)(156.7±34.0 ng/L) in hepatitis B group were significantly higher than those of CHE (5 534±900.4 U/L) and AFP (30.8±12.6 ng/L) in CHB-cirrhosis group (P<0.05). The levels of total bile acid (TBA) (52.7±11.4 μmol/L), total bilirubin (TBil) (95.6±17.5 μmol/L), direct bilirubin (DBil)(62.7±8.6 μmol/L) and prothrombin time (PT)(14.7±9.5s) in CHB group were significantly lower than those of TBA (67.5±15.5 μmol/L), TBil (349.7±62.2 μmol/L), DBil (214.0±18.7 μmol/L), PT (30.5±12.9 s) in CHB-cirrhosis group (P<0.05). The levels of ALB (30.3±7.2), CHE (7 005±890.4 U/L) and AFP (139.5±28.7 ng/L) in the effective treatment group were significantly higher than those of ALB (25.3±9.4), CHE (5 021±976.4 U/L) and AFP (29.8±4.7 ng/L) in the ineffective treatment group (P<0.05). The levels of TBA (40.7±18.2 μmol/L), TBil (96.5±15.3 μmol/L), DBil (53.5±7.2 μmol/L), PT (15.4±8.9 s) in the effective treatment group were significantly lower than those of TBA (50.9±20.4 μmol/L), TBil (350.6±50.8 μmol/L), DBil (218.0±20.7 μmol/L), PT (29.7±11.4 s) in the ineffective treatment group (P<0.05). In the CHB group and the CHB- cirrhosis group, the difference in the prognosis between effective and the ineffective treatment groups was statistically significant (P<0.05).Conclusion ACLF occurs after withdrawal of nucleoside (acid) analogues in CHB and CHB-cirrhosis patients and imposes a great impact on their prognosis. Cautious should be taken for discontinuing anti-viral agents.

Key words: Nucleoside(acid) analogues, After drug withdrawal, Hepatitis B associated acute liver failure

HU Da-shan, LIU huan, XUAN Ji. The clinical characteristics of HBV related acute on chronic liver failure patients with hepatitis B after withdrawal of nucleoside (acid) analogues[J]. Chinese Hepatolgy, 2022, 27(1): 54-57.

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