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Risk of different precipitating events for progressing to acute-on-chronic liver failure in HBV-related cirrhotic patients.
J Dig Dis. 2017 May; 18(5):292-301.JD

Abstract

OBJECTIVE

Acute-on-chronic liver failure (ACLF) is a distinct syndrome that develops in patients with cirrhosis and acute decompensation (AD). This study focused on the precipitating events (PEs) of hepatitis B virus (HBV)-related cirrhotic patients diagnosed as ACLF based on the Chronic Liver Failure Consortium organ failure (CLIF-C OF) score.

METHODS

Hospitalized patients with HBV-related cirrhosis and AD were retrospectively included. The patients' characteristics, laboratory test results, PEs, CLIF-C OF score and short-term prognosis were evaluated.

RESULTS

Of the 890 patients enrolled 300 (33.7%) were diagnosed as ACLF and 590 (66.3%) without ACLF. ACLF patients had a higher incidence of PEs than those without ACLF. The ACLF patients were more prone to having PEs of bacterial infection (P < 0.001), HBV reactivation (P < 0.001), active alcoholism (P = 0.036) and superimposed hepatitis virus infection (P = 0.031), whereas portal vein thrombosis (P = 0.002) were less common in the non-ACLF group. ACLF patients with the top four single PEs had diverse types of organ failures. However, they shared a similar short-term prognosis. While in patients without PEs the ACLF group had higher systemic inflammation and deterirated outcomes compared with the non-ACLF group.

CONCLUSIONS

PEs of bacterial infection, HBV reactivation, active alcoholism and superimposed hepatitis virus infection, but not GI hemorrhage or portal vein thrombosis, were risk factors for ACLF. There may be two types of patients with ACLF based on the differences in the clinical manifestation of the disease.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28485081

Citation

Yin, Shan, et al. "Risk of Different Precipitating Events for Progressing to Acute-on-chronic Liver Failure in HBV-related Cirrhotic Patients." Journal of Digestive Diseases, vol. 18, no. 5, 2017, pp. 292-301.
Yin S, Wang SJ, Gu WY, et al. Risk of different precipitating events for progressing to acute-on-chronic liver failure in HBV-related cirrhotic patients. J Dig Dis. 2017;18(5):292-301.
Yin, S., Wang, S. J., Gu, W. Y., Zhang, Y., Chen, L. Y., & Li, H. (2017). Risk of different precipitating events for progressing to acute-on-chronic liver failure in HBV-related cirrhotic patients. Journal of Digestive Diseases, 18(5), 292-301. https://doi.org/10.1111/1751-2980.12480
Yin S, et al. Risk of Different Precipitating Events for Progressing to Acute-on-chronic Liver Failure in HBV-related Cirrhotic Patients. J Dig Dis. 2017;18(5):292-301. PubMed PMID: 28485081.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of different precipitating events for progressing to acute-on-chronic liver failure in HBV-related cirrhotic patients. AU - Yin,Shan, AU - Wang,Shi Jin, AU - Gu,Wen Yi, AU - Zhang,Yan, AU - Chen,Liu Ying, AU - Li,Hai, PY - 2017/03/14/received PY - 2017/04/24/revised PY - 2017/05/05/accepted PY - 2017/5/10/pubmed PY - 2018/4/10/medline PY - 2017/5/10/entrez KW - acute-on-chronic liver failure KW - hepatitis B virus KW - liver cirrhosis KW - precipitating event SP - 292 EP - 301 JF - Journal of digestive diseases JO - J Dig Dis VL - 18 IS - 5 N2 - OBJECTIVE: Acute-on-chronic liver failure (ACLF) is a distinct syndrome that develops in patients with cirrhosis and acute decompensation (AD). This study focused on the precipitating events (PEs) of hepatitis B virus (HBV)-related cirrhotic patients diagnosed as ACLF based on the Chronic Liver Failure Consortium organ failure (CLIF-C OF) score. METHODS: Hospitalized patients with HBV-related cirrhosis and AD were retrospectively included. The patients' characteristics, laboratory test results, PEs, CLIF-C OF score and short-term prognosis were evaluated. RESULTS: Of the 890 patients enrolled 300 (33.7%) were diagnosed as ACLF and 590 (66.3%) without ACLF. ACLF patients had a higher incidence of PEs than those without ACLF. The ACLF patients were more prone to having PEs of bacterial infection (P < 0.001), HBV reactivation (P < 0.001), active alcoholism (P = 0.036) and superimposed hepatitis virus infection (P = 0.031), whereas portal vein thrombosis (P = 0.002) were less common in the non-ACLF group. ACLF patients with the top four single PEs had diverse types of organ failures. However, they shared a similar short-term prognosis. While in patients without PEs the ACLF group had higher systemic inflammation and deterirated outcomes compared with the non-ACLF group. CONCLUSIONS: PEs of bacterial infection, HBV reactivation, active alcoholism and superimposed hepatitis virus infection, but not GI hemorrhage or portal vein thrombosis, were risk factors for ACLF. There may be two types of patients with ACLF based on the differences in the clinical manifestation of the disease. SN - 1751-2980 UR - https://www.unboundmedicine.com/medline/citation/28485081/Risk_of_different_precipitating_events_for_progressing_to_acute_on_chronic_liver_failure_in_HBV_related_cirrhotic_patients_ L2 - https://doi.org/10.1111/1751-2980.12480 DB - PRIME DP - Unbound Medicine ER -