ABSTRACT
ObjectiveTo investigate the influencing factors for the prognosis of patients with acute－on－chronic liver failure （ACLF）， and to establish a short－term prognostic model. MethodsA retrospective analysis was performed for the baseline clinical data of 247 patients with ACLF who were hospitalized in Department of Infectious Diseases， The First Affiliated Hospital of Xi’an Jiaotong University， from January 2011 to December 2016， and the patients were divided into survival group and death group. The two groups were compared to identify the influencing factors for prognosis； a prognostic model was established， and the receiver operating characteristic （ROC） curve was used to assess its predictive efficacy and determine the optimal cut－off value. The independent－samples t test was used for comparison of normally distributed continuous data between groups， and the Mann－Whitney U rank sum test was used for comparison of non－normally distributed continuous data between groups； the Fisher’s exact test or the Pearson’s chi－square test was used for comparison of categorical data between groups. The univariate and multivariate logistic regression analyses were used to investigate the independent risk factors for 28－ and 90－day prognosis， and the Kaplan－Meier method was used to plot the 28－day survival curves. ResultsA total of 220 patients with ACLF were included based on the inclusion and exclusion criteria； there were 148 patients in the 28－day survival group and 72 patients in the 28－day death group， with a 28－day transplantation－free survival rate of 67.27%； there were 115 patients in the 90－day survival group and 105 patients in the 90－day death group， with a 90－day transplantation－free survival rate of 52.27%. The logistic regression analysis showed that female sex （odds ratio ［OR］=2.149， P=0.030）， high Model for End－Stage Liver Disease （MELD） score （OR=1.120， P<0.001）， and low lymphocyte count （OR=0.411， P=0.002） were independent risk factors for 28－day prognosis， and an LS－MELD model for 28－day prognosis was established as Logit （28－day prognosis）=－3.432+0.765×sex－0.890×lymphocyte count×10－9+0.113×MELD（1 for male sex and 2 for female sex）. The ROC curve analysis showed that this model had an optimal cut－off value of 0.35， and then the patients were divided into low LS－MELD group （≤0.35） and high LS－MELD group （>0.35）； the low LS－MELD group had a significantly higher 28－day survival rate than the high LS－MELD group （P<0.001）. ConclusionPeripheral blood lymphocyte count combined with sex and MELD score has a certain value in predicting the short－term prognosis of ALCF patients.
ABSTRACT
ObjectiveTo investigate the composition and changing trend of the etiologies of liver failure in Shaanxi Province, China. MethodsA retrospective analysis was performed for the clinical data of 975 patients with liver failure who were hospitalized in The First Affiliated Hospital of Xi’an Jiaotong University from January 2008 to December 2017. According to the clinical type of liver failure, the patients were divided into acute liver failure (ALF) group with 115 patients, subacute liver failure (SALF) group with 165 patients, and acute-on-chronic liver failure (ACLF) group with 695 patients. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the t-test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups. ResultsDrug was the primary cause of ALF (25.22%, 29/115), followed by hepatitis B virus (HBV) infection (21.74%, 25/115); HBV infection was the primary cause of SALF (35.15%, 58/165), followed by drug (27.27%, 45/165); HBV infection was the primary cause of ACLF (87.19%, 606/695), followed by alcohol (3.45%, 24/695). The main age distribution of patients with liver failure due to HBV infection, alcohol, and drug was 20-60 years (595/689), 30-40 years (22/32), and 30-70 years (67/89), respectively. There was a significant reduction in the proportion of patients with HBV-related liver failure in the recent 5 years (61.52% vs 81.33%, χ2=45.87, P＜0.001), while there were significant increases in the proportion of patients with drug-induced liver failure (13.14% vs 4.44%, χ2=22.10, P＜0.001) and alcoholic liver failure (4.76% vs 1.56%, χ2=7.85, P=0005). Further analysis showed that the age of onset of HBV-related liver failure in the recent 5 years was significantly higher than that in the first 5 years (45.3±13.0 vs 42.5±12.9, t=-2.567, P=0.011). ConclusionManagement of chronic HBV infection is still an important link in the control of liver failure, and meanwhile, the prevention and treatment of drug-induced and alcoholic liver diseases should be strengthened. More attention should be paid to the treatment of elderly patients with liver failure.
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Objective To observe the dynamic characteristics of hepatitis B core antibody (anti-HBc) titers in chronic hepatitis B (CHB) patients treated with interferon and to explore the predictive value of anti-HBc for response to interferon.Methods The clinical information of the patients diagnosed with CHB in Department of Infectious Diseases , the First Affiliated Hospital of Xi′an Jiaotong University from October 2011 to October 2014 were collected.HBV DNA, liver function and HBV serological markers of CHB patients were tested dynamically during and after interferon treatment.The dynamic characteristics of anti-HBc titers in patients with different virological responses were analyzed.The predictive values of anti-HBc titer for the efficacy of interferon treatment of CHB patients were analyzed by binary logistic regression .Results Of the 42 CHB patients aging(30.8 ±10.1) years old, 34 patients were hepatitis B e antigen (HBeAg) positive and 8 were negative.All patients completed 48-week interferon treatment and 24-week follow-up after the end of treatment. Among them, 28.6%( 12/42), 26.2%( 11/42 ) and 45.2%( 19/42 ) of patients achieved sustained virological response (SVR), virological relapse ( VR) and non-response ( NR), respectively.Patients with different virological response presented various characteristics of anti -HBc titers.Compared with NR group, the anti-HBc titers at baseline and week 12 were significantly higher in SVR group (at baseline: [4.93 ±0.30] vs [4.70 ±0.33] lg IU/mL, t ＝2.147, P ＝0.013; at week 12: [4.83 ± 0.23] vs [4.44 ± 0.41] lg IU/mL, t＝3.032, P＝0.007).The anti-HBc titers in SVR group at week 12 and week 24 were significantly higher than those in VR group (at week 12: [4.83 ±0.23] vs [4.67 ±0.51] lg IU/mL, t＝2.400, P＝0.039; at week 24: [4.73 ±0.21] vs [4.55 ±0.50] lg IU/mL, t＝2.542, P＝0.039).By multivariate logistic regression analysis, the anti-HBc titer at baseline was the independent predictive factor for SVR in CHB patients treated with interferon (OR＝6.000, 95%CI: 1.118 -20.486, P＝0.037).The area under receiver operating characteristics curve was 0.753 and the optimal cutoff value of anti-HBc titer for the response to interferons in CHB patients was 5.03 lg IU/mL, with positive predictive value of 64.3%and negative predictive value of 89.3%.Conclusions Dynamic pattern of anti-HBc titers is correlated with different virological responses in CHB patients treated with interferon , and the baseline anti-HBc titer is the independent predictive factor for SVR.
ABSTRACT
ObjectiveTo investigate the composition and changing trend of the etiologies of liver failure in Shaanxi Province, China. MethodsA retrospective analysis was performed for the clinical data of 975 patients with liver failure who were hospitalized in The First Affiliated Hospital of Xi’an Jiaotong University from January 2008 to December 2017. According to the clinical type of liver failure, the patients were divided into acute liver failure (ALF) group with 115 patients, subacute liver failure (SALF) group with 165 patients, and acute-on-chronic liver failure (ACLF) group with 695 patients. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the t-test was used for further comparison between two groups; the chi-square test was used for comparison of categorical data between groups. ResultsDrug was the primary cause of ALF (25.22%, 29/115), followed by hepatitis B virus (HBV) infection (21.74%, 25/115); HBV infection was the primary cause of SALF (35.15%, 58/165), followed by drug (27.27%, 45/165); HBV infection was the primary cause of ACLF (87.19%, 606/695), followed by alcohol (3.45%, 24/695). The main age distribution of patients with liver failure due to HBV infection, alcohol, and drug was 20-60 years (595/689), 30-40 years (22/32), and 30-70 years (67/89), respectively. There was a significant reduction in the proportion of patients with HBV-related liver failure in the recent 5 years (61.52% vs 81.33%, χ2=45.87, P＜0.001), while there were significant increases in the proportion of patients with drug-induced liver failure (13.14% vs 4.44%, χ2=22.10, P＜0.001) and alcoholic liver failure (4.76% vs 1.56%, χ2=7.85, P=0005). Further analysis showed that the age of onset of HBV-related liver failure in the recent 5 years was significantly higher than that in the first 5 years (45.3±13.0 vs 42.5±12.9, t=-2.567, P=0.011). ConclusionManagement of chronic HBV infection is still an important link in the control of liver failure, and meanwhile, the prevention and treatment of drug-induced and alcoholic liver diseases should be strengthened. More attention should be paid to the treatment of elderly patients with liver failure.