Etiology and related clinical indicators of liver failure: an analysis of 3-year case data of Wuxi designated hospital for treatment of liver failure / 中华危重病急救医学

ABSTRACT

Objective:To analyze the characteristics of etiology and clinical indicators of hepatitis B virus (HBV) and non-HBV liver failure, and to evaluate their potential roles in reflecting disease outcomes.Methods:The clinical data of 369 patients with liver failure admitted to the intensive care unit (ICU) of the Fifth People's Hospital of Wuxi which was the designated hospital for treatment of liver failure from January 2018 to December 2020 were retrospectively analyzed. The classification and comparison of etiology of non-HBV and HBV liver failure patients were performed according to the Guidelines on the Diagnosis and Treatment of Liver Failure (2018 edition). The indicators of liver failure related etiologies, including gender, age, anticoagulant enzyme Ⅲ (ATⅢ), total bilirubin (TBil), length of ICU stay, hepatic encephalopathy, underlying disease (liver cirrhosis and liver cancer, etc.) and usage of artificial liver were analyzed. According to the 6-month follow-up results after discharge, the differences in the etiological indicators of died and survival patients and the outcome of patients with different types of liver failure were analyzed. Results:A total of 369 patients were enrolled, including 134 (36.3%) with liver failure not caused by HBV and 235 (63.7%) with liver failure caused by HBV. The male with HBV-related liver failure was 4.34 times higher than female (cases 191 vs. 44), which was higher than non-HBV-related liver failure (1.03 times, cases 68 vs. 66). The 6-month follow-up showed that the proportion of male with HBV-related liver failure who died and survived was significantly higher than that of female (78.76% vs. 21.24% in died patients, 92.86% vs. 7.14% in survival patients, both P < 0.01). The age of died patients in the non-HBV-related liver failure group was significantly higher than that of the survival patients (years 58.53±0.15 vs. 54.38±3.01, P < 0.05), and the ATⅢ level was significantly lower than that of the survival patients [(32.20±6.43)% vs. (38.63±2.74)%, P < 0.05]. The length of ICU stay of the died HBV-related liver failure group was significantly shorter than that of the survival patients (days 23.77±11.74 vs. 35.51±2.85, P < 0.01). The 6-month mortality after discharge of HBV-related liver failure combined with liver cancer was significantly higher than that of non-HBV-related liver failure (12.34% vs. 2.24%, P < 0.01), but there was no significant difference in 6-month mortality after discharge of patients receiving artificial liver and those with hepatic encephalopathy and cirrhosis between different types of liver failure groups. Conclusions:HBV is the main cause of liver failure. Patients with HBV-related liver failure were younger and had a longer hospitalization period, which was conducive to the recovery of the disease. HBV-related liver failure accompanied with liver cancer is the main factors of death. The ATⅢ has the potential value to reflect the disease outcome.