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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2022; 28(31): 4417-4430
Published online Aug 21, 2022. doi: 10.3748/wjg.v28.i31.4417
Published online Aug 21, 2022. doi: 10.3748/wjg.v28.i31.4417
Prevalence and clinical characteristics of autoimmune liver disease in hospitalized patients with cirrhosis and acute decompensation in China
Zi-Xuan Shen, Dan-Dan Wu, Wen-Yi Gu, Yan Zhang, Jian-Yi Wei, Xiong Ma, Hai Li, Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Zi-Xuan Shen, Dan-Dan Wu, Wen-Yi Gu, Yan Zhang, Jian-Yi Wei, Xiong Ma, Hai Li, Shanghai Institute of Digestive Disease, Key Laboratory of Gastroenterology and Hepatology, Chinese Ministry of Health, Shanghai Jiao Tong University, Shanghai 200001, China
Jie Xia, Wen-Ting Tan, Guo-Hong Deng, Department of Infectious Diseases, Southwest Hospital, The Third Military Medical University (Army Medical University), Chongqing 400038, China
Xian-Bo Wang, Yi-Xin Hou, Qun Zhang, Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100102, China
Xin Zheng, Yan Xiong, Cong-Cong Zou, Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
Yan Huang, Jun Chen, Ze-Bing Huang, Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
Bei-Ling Li, Jun Chen, Xiu-Hua Jiang, Jin-Jun Chen, Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Zhong-Ji Meng, Sen Luo, Yuan-Yuan Chen, Department of Infectious Disease, Taihe Hospital, Hubei University of Medicine, Shiyan 430418, Hubei Province, China
Yan-Hang Gao, Na Gao, Chun-Yan Liu, Department of Hepatology, The First Hospital of Jilin University, Changchun 130031, Jilin Province, China
Zhi-Ping Qian, Wei Yuan, Xue Mei, Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai 201508, China
Feng Liu, Tianjin Institute of Hepatology, Nankai University Second People’s Hospital, Tianjin 300102, China
Feng Liu, Jing Li, Tao Li, Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China
Xiao-Bo Lu, Xin-Yi Zhou, Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang, China
Jia Shang, Department of Infectious Diseases, Henan Provincial People’s Hospital, Zhengzhou 450003, Henan Province, China
Hua-Dong Yan, Department of Infectious Diseases, Hwamei Hospital, The Second Hospital of Ningbo, University of Chinese Academy of Sciences, Ningbo 315153, Zhejiang Province, China
Yu-Bao Zheng, Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
Author contributions: Shen ZX, Wu DD, Xia J, Wang XB, Zheng X, Huang Y and Li BL contributed equally to this work; Ma X and Li H contributed equally to this work; Li H generated the concept and designed the research; all authors acquired the data; Shen ZX, Wu DD performed statistical analysis; Shen ZX, Wu DD, Xia J, Wang XB generated the results; Shen ZX, Wu DD, Zheng X, Huang Y and Li BL interpreted the results; Shen ZX and Wu DD drafted the manuscript which was revised by Ma X and Li H for important intellectual content; Ma X made important contribution patient recruitment; Li H was responsible for administrative, technical, or material support and study supervision; and all authors have access to the data, approved this final version of the manuscript and are accountable for all aspects.
Supported by Shanghai Hospital Development Commission , No. SHDC2020CR1037B ; the National Key R&D Program of China , No. 2017YFC0908100 ; the National Science and Technology Major Project , No. 2018ZX10302206, 2018ZX10723203 and 2017ZX10202202; Shanghai Municipal Education Commission-Guofeng Clinical Medicine Grant , No. 20152213 ; the National Natural Science Foundation of China , No. 82170629, 81930061, 81900579, 81970550, 82070613, 82070650, and 81972265; Chongqing Natural Science Foundation , No. CSTC2019jcyj-zdxmX0004 ; Beijing Municipal Science & Technology Commission , No. Z191100006619033 ; Local Innovative and Research Teams Project of Guangdong Pearl River Talents Program , No. 2017BT01S131 ; the Foundation for Innovative Research Groups of Hubei Provincial Natural Science Foundation , No. 2018CFA031 ; and Guangdong Basic and Applied Basic Research Foundation , No. 2020A1515010052 .
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki. The Medical Ethics Board of Shanghai Renji Hospital, Shanghai, China, approved the studies (ethics codes: [2014]148k and [2016]142k).
Informed consent statement: Informed consent was obtained from all patients for being included in the study.
Conflict-of-interest statement: All authors declare that they have no conflict of interest in this manuscript.
Data sharing statement: Data are available within 1 year after publication upon reasonable request via email: aclf_group@163.com .
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hai Li, MD, Professor, Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1630 Dongfang Road, Shanghai 200127, China. hai_17@126.com
Received: March 3, 2022
Peer-review started: March 3, 2022
First decision: April 25, 2022
Revised: May 19, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: August 21, 2022
Peer-review started: March 3, 2022
First decision: April 25, 2022
Revised: May 19, 2022
Accepted: July 25, 2022
Article in press: July 25, 2022
Published online: August 21, 2022
ARTICLE HIGHLIGHTS
Research background
Epidemiological research on autoimmune liver disease (AILD) in patients with end-stage liver disease is sparse in Asian-pacific areas.
Research motivation
This study aimed to provide a national view of epidemiological features of end-stage AILD in China.
Research objectives
To investigate the disease burden and risk factor of short-term mortality in AILD patients with cirrhosis and acute decompensation (AD), and thus provide clues on clinical management.
Research methods
Data were collected from two prospective, multicenter cohorts which enrolled patients with chronic liver disease and acute exacerbation from China. Logistic regression model was conducted to analyze risk factors.
Research results
The overall prevalence of AILD was 9.3% (242/2597) in patients with cirrhosis and AD, among which primary biliary cirrhosis was the most prevalent type. The etiology of AILD had no significant impact on short-term mortality in patients with cirrhosis and AD in univariate and multivariate analysis. Total bilirubin, hepatic encephalopathy (HE) and blood urea nitrogen independently correlated with 90-d LT-free mortality in multivariate analysis.
Research conclusions
AILD was not rare in hospitalized patients with cirrhosis and AD in China. 90-d mortality was independently associated with severity of the disease.
Research perspectives
In clinical management of AILD, strategies are needed to prevent presence of HE and closely monitor the changes of liver and renal function.