Predictors of the outcomes of acute-on-chronic hepatitis B liver failure

Table 1 Patient characteristics and blood tests on the day of diagnosis

	Survival	Dead	P value
Case number	52	61
Age (yr)1	43.00 (17.00)	55.00 (19.00)	< 0.001
BMI1	25.15 (5.54)	23.41 (6.35)	0.668
Gender: Male	42 (80.8%)	45 (73.8%)	0.378
Past history: Yes
Diabetes mellitus2	3 (5.8%)	18 (29.5%)	0.001
Hypertension2	9 (17.3%)	20 (32.8%)	0.060
Coronary artery disease3	1 (1.9%)	6 (9.8%)	0.122
Cirrhosis2	34 (65.4%)	45 (73.8%)	0.333
Blood culture: Positive2	2 (3.8%)	22 (36.1%)	< 0.001
Gastroenteric tract bleeding2	8 (15.4%)	18 (29.5%)	0.075
Laboratory investigation
WBC count (×103/cumm)1	7.00 (3.60)	7.10 (6.55)	0.668
Hemoglobin (g/dL)1	11.80 (4.90)	10.70 (3.85)	0.879
Platelet (×103/cumm)1	91.00 (108.00)	89.50 (92.50)	0.826
Prothrombin time (s)1	18.00 (4.47)	19.90 (7.45)	0.060
INR1	2.23 (1.08)	2.66 (1.51)	0.084
Creatinine (mg/dL)1	0.80 (0.70)	0.80 (1.00)	0.109
ALT (U/L)1	71.00 (1091.00)	180.00 (833.50)	0.250
Total bilirubin (mg/dL)1	15.35 (9.65)	13.95 (12.20)	0.425
Direct bilirubin (mg/dL)1	7.50 (7.60)	7.50 (9.40)	0.642
Cholesterol (mg/dL)1	108.00 (64.50)	104.00 (52.00)	0.208
Triglyceride (mg/dL)1	99.00 (62.00)	94.00 (62.00)	0.164
Albumin (g/dL)1	2.90 (0.80)	2.60 (0.88)	0.386
Ammonia (μg/dL)1	124.00 (75.50)	138.00 (159.00)	0.133
Serum sodium (mmol/L)1	135.00 (6.50)	135.00 (7.50)	0.739
Serum potassium (mmol/L)1	3.70 (1.02)	4.10 (1.15)	0.008
Serum chloride (mmol/L)1	105.00 (9.00)	106.00 (9.00)	0.207
Serum calcium (mg/dL)1	8.30 (0.70)	8.10 (0.80)	0.517
Serum magnesium (mg/dL)1	2.00 (0.55)	2.00 (0.67)	0.670
MELD score1	26.00 (6.00)	29.00 (10.00)	0.091
APACHE-II score1	12.00 (5.00)	14.00 (3.00)	< 0.001

P values were derived from

¹the Mann-Whitney U test,

²the χ² test, and

³Fisher’s exact test. The median (interquartile range) is presented for continuous variables and the number (percentage) is presented for categorical variables. MELD: Model for end-stage liver disease; APACHE-II: Acute Physiology and Chronic Health Evaluation II; INR: International normalized ratio; ALT: Alanine transaminase; WBC: White blood cell.

Table 2 Univariate and multivariate analysis of clinical and biochemical data on the day of diagnosis

	Univariate analysis		Multivariate analysis
	OR (95% CI)	P value	OR (95% CI)	P value
Age ≥ 45	6.912 (3.009-15.879)	< 0.001	NI
Serum potassium ≥ 4.0	1.994 (0.928-4.284)	0.077	NI
APACHE-II score ≥ 12	7.167 (3.072-16.724)	< 0.001	7.160 (2.834-18.092)	< 0.001
Blood culture: Positive	14.103 (3.125-63.639)	0.001	13.520 (2.740-66.721)	0.001
Past diabetes history: Positive	6.837 (1.884-24.814)	0.003	NI

Age and history of diabetes mellitus were not included for multivariate analyses because these parameters had been calculated for the APACHE-II score. OR: Odds ratio; APACHE-II: Acute Physiology and Chronic Health Evaluation II; NI: Not included in model.

Table 3 Laboratory tests after the first week of anti-hepatitis B virus therapy

	Survivors (n = 52)	Dead (n = 61)	P value
White blood cell count	6.50 (3.40)	9.35 (6.95)	< 0.001
(×103/cumm )
Hemoglobin (g/dL)	10.25 (1.95)	0.20 (3.70)	0.780
Platelet (×103/cumm)	92.50 (74.50)	79.50 (91.25)	0.356
Prothrombin time (s)	17.20 (4.85)	21.65 (9.35)	< 0.001
INR	1.96 (1.00)	2.87 (2.38)	< 0.001
Creatinine (mg/dL)	0.70 (0.50)	1.10 (1.35)	< 0.001
ALT (U/L)	95.50 (331.25)	115.50 (299.00)	0.238
Total bilirubin (mg/dL)	12.75 (9.60)	20.30 (15.20)	0.003
Direct bilirubin (mg/dL)	7.45 (7.85)	10.30 (8.60)	0.093
Albumin (g/dL)	3.00 (0.70)	2.80 (0.85)	0.098
Ammonia (μg/dL)	118.00 (96.00)	159.50 (223.00)	0.005
Serum sodium (mmol/L)	134.00 (8.00)	138.00 (8.00)	0.003
Serum potassium (mmol/L)	4.10 (0.90)	3.80 (1.00)	0.649
Serum chloride (mmol/L)	104.00 (14.00)	105.00 (18.00)	0.338
Serum calcium (mg/dL)	8.40 (1.25)	8.45 (1.43)	0.922
Serum magnesium (mg/dL)	1.80 (1.45)	2.30 (0.93)	0.216
MELD score	25.00 (7.00)	32.00 (12.00)	< 0.001
APACHE-II score	13.00 (10.00)	17.50 (9.00)	0.014

The median (interquartile range) is presented for continuous variables. P values were derived using the Mann-Whitney U test. MELD: Model for end-stage liver disease; APACHE-II: Acute Physiology and Chronic Health Evaluation II; INR: International normalized ratio; ALT: Alanine transaminase.

Table 4 Univariate and multivariate analysis of clinical and biochemical data after the first week of anti-hepatitis B virus therapy

	Univariate analysis		Multivariate analysis
	OR (95% CI)	P value	OR (95% CI)	P value
White blood cell count	5.940 (2.129-16.571)	0.001a	NI
≥ 8.50
Prothrombin time ≥ 19	4.018 (1.656-9.747)	0.002a	1.264 (0.254-6.296)	0.775
INR ≥ 2.5	3.960 (1.635-9.590)	0.002a	NI
Creatinine ≥ 0.9	4.819 (2.090-11.112)	< 0.001a	NI
Total bilirubin ≥ 15.5	4.271 (1.878-9.714)	0.001a	NI
Ammonia ≥ 166	4.167 (1.459-11.900)	0.008a	3.976 (0.703-22.482)	0.118
Serum sodium ≥ 136	3.479 (1.432-8.448)	0.006a	NI
MELD score ≥ 28	13.000 (4.604-36.711)	< 0.001a	8.182 (1.884-35.527)	0.005
APACHE-II score ≥ 14	2.941 (1.201-7.203)	0.018a	1.597 (0.375-6.809)	0.527

The parameters of white blood cell count, serum sodium, INR, total bilirubin and creatinine were not included for multivariate analyses because these parameters had been calculated for the APACHE-II score or MELD score. OR: Odds ratio; MELD: Model for end-stage liver disease; APACHE-II: Acute Physiology and Chronic Health Evaluation II; INR: International normalized ratio; NI: Not included in model.

^aP < 0.05.