Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2022; 10(23): 8186-8195
Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8186
Short-term prognostic factors for hepatitis B virus-related acute-on-chronic liver failure
Qiao-Xia Ye, Jin-Fa Huang, Zheng-Ju Xu, Yan-Yan Yan, Yan Yan, Li-Guan Liu
Qiao-Xia Ye, Jin-Fa Huang, Zheng-Ju Xu, Yan-Yan Yan, Yan Yan, Li-Guan Liu, Department of Infectious Diseases, The 910th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Quanzhou 362000, Fujian Province, China
Author contributions: Ye QX and Huang JF wrote the manuscript; Xu ZJ and Yan YY collected the data; Yan Y and Liu LG analyzed the data.
Supported by Science and Technology Project of Quanzhou to Dr. Zhengju Xu, No. 2017Z018.
Institutional review board statement: The study was approved by the Ethics Committee of the 910th Hospital of Chinese People's Liberation Army (No. 32).
Informed consent statement: Informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All the data used to support the findings of this study are included within the article.
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: Li-Guan Liu, MD, Professor, Department of Infectious Diseases, The 910th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, No. 180 Huayuan Road, Fengze District, Quanzhou 362000, Fujian Province, China. liuliguan8255@126.com
Received: January 24, 2022
Peer-review started: January 24, 2022
First decision: March 8, 2022
Revised: May 12, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: August 16, 2022
Processing time: 189 Days and 0.4 Hours
Abstract
BACKGROUND

Acute-on-chronic liver failure (ACLF) is the abrupt exacerbation of declined hepatic function in patients with chronic liver disease.

AIM

To explore the independent predictors of short-term prognosis in patients with hepatitis B virus (HBV)-related ACLF and to establish a predictive short-term prognosis model for HBV-related ACLF.

METHODS

From January 2016 to December 2019, 207 patients with HBV-related ACLF attending the 910th Hospital of Chinese People's Liberation Army were continuously included in this retrospective study. Patients were stratified based on their survival status 3 mo after diagnosis. Information was collected regarding gender and age; coagulation function in terms of prothrombin time and international normalized ratio (INR); hematological profile in terms of neutrophil-to-lymphocyte ratio (NLR) and platelet count (PLT); blood biochemistry in terms of alanine aminotransferase, aspartate aminotransferase, total bilirubin (Tbil), albumin, cholinesterase, blood urea nitrogen (BUN), creatinine, blood glucose, and sodium (Na); tumor markers including alpha-fetoprotein (AFP) and Golgi protein 73 (GP73); virological indicators including HBV-DNA, HBsAg, HBeAg, Anti-HBe, and Anti-HBc; and complications including hepatic encephalopathy, hepatorenal syndrome, spontaneous peritonitis, gastrointestinal bleeding, and pulmonary infection.

RESULTS

There were 157 and 50 patients in the survival and death categories, respectively. Univariate analysis revealed significant differences in age, PLT, Tbil, BUN, NLR, HBsAg, AFP, GP73, INR, stage of liver failure, classification of liver failure, and incidence of complications (pulmonary infection, hepatic encephalopathy, spontaneous bacterial peritonitis, and upper gastrointestinal bleeding) between the two groups (P < 0.05). GP73 [hazard ratio (HR): 1.009, 95% confidence interval (CI): 1.005-1.013, P = 0.000], middle stage of liver failure (HR: 5.056, 95%CI: 1.792-14.269, P = 0.002), late stage of liver failure (HR: 22.335, 95%CI: 8.544-58.388, P = 0.000), pulmonary infection (HR: 2.056, 95%CI: 1.145-3.690, P = 0.016), hepatorenal syndrome (HR: 6.847, 95%CI: 1.930-24.291, P = 0.003), and HBsAg (HR: 0.690, 95%CI: 0.524-0.908, P = 0.008) were independent risk factors for short-term prognosis in patients with HBV-related ACLF. Following binary logistics regression analysis, we arrived at the following formula for predicting short-term prognosis: Logit(P) = Ln(P/1-P) = 0.013 × (GP73 ng/mL) + 1.907 × (middle stage of liver failure) + 4.146 × (late stage of liver failure) + 0.734 × (pulmonary infection) + 22.320 × (hepatorenal syndrome) - 0.529 × (HBsAg) - 5.224. The predictive efficacy of the GP73-ACLF score was significantly better than that of the Model for End-Stage Liver Disease (MELD) and MELD-Na score models (P < 0.05).

CONCLUSION

The stage of liver failure, presence of GP73, pulmonary infection, hepatorenal syndrome, and HBsAg are independent predictors of short-term prognosis in patients with HBV-related ACLF, and the GP73-ACLF model has good predictive value among these patients.

Keywords: Hepatitis B virus; Acute-on-chronic liver failure; Golgi protein 73; Short-term prognosis model

Core Tip: The stage of liver failure, presence of Golgi protein 73 (GP73), pulmonary infection, hepatorenal syndrome, and HBsAg are independent predictors of short-term prognosis in patients with hepatitis B virus-related acute-on-chronic liver failure (ACLF). In addition, the GP73-ACLF model has good predictive value, in the short term, among these patients.