Static and dynamic prognostic factors for hepatitis-B-related acute-on-chronic liver failure
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background/Aims: Hepatitis-B-related acute-on-chronic liver failure has a poor prognosis. However, the advent of potent oral antiviral agents means that some patients can now recover with medical treatment. We aimed to identify the prognostic factors for hepatitis-B-related acute-on-chronic liver failure including the initial as well as the dynamically changing clinical parameters during admission. Methods: Sixty-seven patients were retrospectively enrolled from 2003 to 2012 at Samsung Medical Center. The patients were classified into three categories: Recovery group (n=23), Liver transplantation group (n=28), and Death group (n=16). The Liver transplantation and Death groups were combined into an Unfavorable prognosis group. We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals. Results: A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (≥28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (≥grade III) (OR=15.41, P=0.013). Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P=0.016). Conclusions: Dynamic changes in clinical parameters during admission are useful prognostic factors for hepatitis-B-related acute-on-chronic liver failure. (Clin Mol Hepatol 2015;21:232-241)
Abstract
Background/Aims: Hepatitis-B-related acute-on-chronic liver failure has a poor prognosis. However, the advent of potent oral antiviral agents means that some patients can now recover with medical treatment. We aimed to identify the prognostic factors for hepatitis-B-related acute-on-chronic liver failure including the initial as well as the dynamically changing clinical parameters during admission. Methods: Sixty-seven patients were retrospectively enrolled from 2003 to 2012 at Samsung Medical Center. The patients were classified into three categories: Recovery group (n=23), Liver transplantation group (n=28), and Death group (n=16). The Liver transplantation and Death groups were combined into an Unfavorable prognosis group. We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals. Results: A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (≥28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (≥grade III) (OR=15.41, P=0.013). Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P=0.016). Conclusions: Dynamic changes in clinical parameters during admission are useful prognostic factors for hepatitis-B-related acute-on-chronic liver failure. (Clin Mol Hepatol 2015;21:232-241)
참고문헌 (21)
- Chang TT, "Long-term entecavir therapy results in the reversal of fibrosis", cirrhosis and continued histological improvement in patients with chronic hepatitis B, 2010, pp.52, 886~893
- "Fact sheet N°204 : Hepatitis B"[URL]
- Seto WK, "Acute-on-chronic liver failure in chronic hepatitis B", J Gastroenterol Hepatol, 27, pp.662~669 (2012)
- Sarin SK, "Acute-on-chronic liver failure : consensus recommendations of the Asian Pacific Association for the study of the liver(APASL)", Hepatol Int, 3, pp.269~282 (2009)
- Lok AS, "Acute exacerbations in Chinese patients with chronic hepatitis B virus (HBV) infection. Incidence, predisposing factors and etiology", J Hepatol 199, 10, pp.29~34 (1990)
- Yuen MF, "Prognostic factors in severe exacerbation of chronic hepatitis B", Clin Infect Dis, 36, pp.979~984 (2003)
- Wlodzimirow KA, "A systematic review on prognostic indicators of acute on chronic liver failure and their predictive value for mortality", Liver Int, 33, pp.40~52 (2013)
- Hwang SJ, "Comparison of three different hybridization assays in the quantitative measurement of serum hepatitis B virus DNA", J Virol Methods, 62, pp.123~129 (1996)
- Polson J, "AASLD position paper : the management of acute liver failure", Hepatology, 41, pp.1179~1197 (2005)
- Kamath PS, "A model to predict survival in patients with endstage liver disease", Hepatology, 33, pp.464~470 (2001)
- Bajaj JS, "Spectrum of neurocognitive impairment in cirrhosis : Implications for the assessment of hepatic encephalopathy", Hepatology, 50, pp.2014~2021 (2009)
- Arroyo V, "Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis. International Ascites Club", Hepatology, 23, pp.164~176 (1996)
- American College of Chest Physicians, "Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis", Crit Care Med, 20, pp.864~874 (1992)
- Yu JW, "Prediction value of model for endstage liver disease scoring system on prognosis in patients with acute-on-chronic hepatitis B liver failure after plasma exchange and lamivudine treatment", J Gastroenterol Hepatol, 23, pp.1242~1249 (2008)
- Zheng MH, "A model to determine 3-month mortality risk in patients with acute-on-chronic hepatitis B liver failure", Clin Gastroenterol Hepatol, 9, pp.351~356 (2011)
- Sun QF, "Prediction of the prognosis of patients with acute-on-chronic hepatitis B liver failure using the model for end-stage liver disease scoring system and a novel logistic regression model", J Viral Hepat, 16, pp.464~470 (2009)
- Wong VW, "Entecavir treatment in patients with severe acute exacerbation of chronic hepatitis B", J Hepatol, 54, pp.236~242 (2011)
- Chen CH, "lamivudine in chronic hepatitis B patients with severe acute exacerbation and hepatic decompensation", J Hepatol, 60, pp.1127~1134 (2014)
- Cui YL, "Nucleoside analogue can improve the long-term prognosis of patients with hepatitis B virus infection-associated acute on chronic liver failure", Dig Dis Sci, 55, pp.2373~2380 (2010)
- Bajaj JS, "Second infections independently increase mortality in hospitalized patients with cirrhosis : the North American consortium for the study of end-stage liver disease(NACSELD)experience", Hepatology, 56, pp.2328~2335 (2012)
- Lee WC, "Indicators and outcome of liver transplantation in acute liver decompensation after flares of hepatitis B", J Viral Hepat, 18, pp.193~199 (2011)