Chinese Hepatolgy ›› 2022, Vol. 27 ›› Issue (12): 1305-1308.

• Liver Failure • Previous Articles     Next Articles

The prognostic impact factors and therapeutic effect evaluation of patients with acute-on-chronic liver failure induced by chronic hepatitis B reactivation

SHAO Song-ze1, ZHU Yong2, LIN Li1   

  1. 1. Department of Emergency Medicine, the Second People's Hospital of Lianyungang, Jiangsu 222000,China;
    2. Department of Hepatology, The Fourth People's Hospital of Lianyungang City, Jiangsu 222000, China
  • Received:2022-07-04 Published:2023-01-30
  • Contact: LIN Li,Email:50201295@qq.com

Abstract: Objective To analyze the prognostic impact factors and therapeutic effect evaluation of patients with acute-on-chronic liver failure (ACLF) induced by chronic hepatitis B (CHB) reactivation.Methods From October 2018 to October 2020, sixty-eight patients (including 37 males and 31 females) with ACLF due to CHB reactivation were selected, with an average age of (45.1±6.0) years. All patients were given individualized comprehensive treatment. On this basis, antiviral drugs including entecavir, lamivudine and adefovir dipivoxil were used alone or in combination. The changes of main indexes of the ACLF patients were observed before and after treatment. The patients were divided into treatment improvement group and ineffective death group based on their different outcomes. Logistic regression analysis was used to indentify the influencing factors of the patients’ outcomes.Results Among 68 patients with ACLF, 48 cases improved after treatment (treatment improvement group) and 20 cases died after ineffective treatment (ineffective death group). According to the general data, the age of treatment improvement group [(41.4±10.2) years] was significantly younger than that of ineffective death group [(50.2±9.7) years (P<0.05). In the treatment improvement group, there were 21 cases (43.7%), 17 cases (35.4%) and 10 cases (20.8%) of hepatitis, compensated cirrhosis and decompensated cirrhosis, respectively, which were significantly more than those of 3 cases (15.0%), 1 case (5.0%) and 16 cases (80.0%) in the ineffective death group (P<0.05). Ascites, upper gastrointestinal bleeding, hepatic encephalopathy and hepatorenal syndrome in the treatment improvement group were 19 cases (39.6%), 2 cases (4.2%), 2 cases (4.2%) and 4 cases (8.3%), respectively, which were significantly lower than those of 16 cases (80.0%), 6 cases (30.0%) in the ineffective death group (P<0.05). The prothrombin time activity (PTA), blood ammonia and serum creatinine levels in the treatment improvement group were (38.6±7.8)%, (38.2±9.0) μmol/L and (62.4±13.2) μmol/L, respectively, which were significantly higher than those of [(27.0±6.6)% and (63.4±15.6) μmol in the ineffective death group (P<0.05). In addition, age, PTA, blood ammonia and serum creatinine levels were verified as independent risk factors to predict death in the ACLF patients due to ineffective treatment (P<0.05). Alanine transaminase (ALT) and HBV DNA decreased significantly after treatment, similarly, Total bilirubin (TBil) level decreased significantly after 12 and 24 weeks of treatment (P<0.05), and PTA decreased significantly before and after 24 weeks of treatment (P<0.05).Conclusion Age, PTA, blood ammonia and serum creatinine levels in this study are independent risk factors that affecting the prognosis of ACLF patients caused by CHB reactivation. Antiviral drugs can significantly improve the condition of the ACLF patients induced by CHB reactivation.

Key words: Chronic hepatitis B, Acute-on-chronic liver failure, Hepatitis B virus, reactivation, Prognosis