Case Control Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2019; 25(19): 2327-2337
Published online May 21, 2019. doi: 10.3748/wjg.v25.i19.2327
Risk factors for progression to acute-on-chronic liver failure during severe acute exacerbation of chronic hepatitis B virus infection
Ling Yuan, Bai-Mei Zeng, Lu-Lu Liu, Yi Ren, Yan-Qing Yang, Jun Chu, Ying Li, Fang-Wan Yang, Yi-Huai He, Shi-De Lin
Ling Yuan, Bai-Mei Zeng, Yan-Qing Yang, Jun Chu, Ying Li, Fang-Wan Yang, Yi-Huai He, Shi-De Lin, Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
Lu-Lu Liu, Department of Gastroenterology, Jiangsu Province Hospital, Pukou Branch, Nanjing 210000, Jiangsu Province, China
Yi Ren, Department of Respiratory Medicine, the Fifth People’s Hospital of Chongqing, Chongqing 400062, China
Author contributions: Yuan L and Zeng BM contributed equally to this work; Yuan L, Zeng BM, Liu LL, Ren Y, Chu J, Yang YQ, and Lin SD performed the research; Yuan L and Zeng BM wrote the manuscript; He YH, Yang FW, Li Ying, and Lin SD performed the biostatistic analysis; Zeng BM, Liu LL, Ren Y, Chu J, Yang YQ, and Lin SD analyzed the data; all authors discussed the results and commented on the manuscript.
Supported by the National Natural Science Foundation of China, No. 81460124 and No. 81860114.
Institutional review board statement: This study was approved by the Institutional Review Board of Affiliated Hospital of Zunyi Medical University, Guizhou Province, China.
Informed consent statement: All patients were informed of the use of their data in writing for clinical research purposes and accepted.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest in this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shi-De Lin, MD, Chief Doctor, Occupational Physician, Professor, Department of Infectious Diseases, Affiliated Hospital of Zunyi Medical University, 201 Dalian street, Zunyi 563003, Guizhou Province, China. linshide6@zmc.edu.cn
Telephone: +86-851-28609183 Fax: +86-851-28609183
Received: February 14, 2019
Peer-review started: February 17, 2019
First decision: March 20, 2019
Revised: March 29, 2019
Accepted: April 19, 2019
Article in press: April 20, 2019
Published online: May 21, 2019
Processing time: 95 Days and 3 Hours
ARTICLE HIGHLIGHTS
Research background

The prognosis of patients with acute-on-chronic liver failure (ACLF) largely depends on early diagnosis and treatment. Patients with acute exacerbation (AE) or severe AE (SAE) of chronic hepatitis B virus (HBV) infection have a high tendency to further progress to hepatic decompensation (HD) and ACLF. Therefore, it is important to identify the risk factors for progression to HD and ACLF in patients with SAE of chronic HBV infection.

Research motivation

In a previous study, we have found that baseline age, HBV DNA, and international normalized ratio levels were independent factors associated with the development of ACLF in patients with AE of chronic HBV infection. Patients with AE or SAE have different degrees of liver injury, and it remains to be elucidated whether the risk factors for progression to ACLF are similar among these patients.

Research objectives

To identify risk factors related to progression to HD and ACLF in compensated patients with SAE of chronic HBV infection.

Research methods

The baseline characteristics of 164 patients with SAE of chronic HBV infection were retrospectively reviewed. Independent risk factors associated with progression to HD and ACLF were identified.

Research results

Independent risk factors associated with progression to HD were liver cirrhosis (LC) and low alanine aminotransferase (ALT). Independent risk factors for progression to ACLF were LC, high MELD score, high aspartate aminotransferase (AST) levels, and low prothrombin activity (PTA).

Research conclusions

Our results are the first to demonstrate that in patients with SAE of chronic HBV infection, compensated LC plays a determining role in the development of both HD and ACLF. High MELD score, high AST, and low PTA are associated with progression to ACLF.

Research perspectives

We found that liver cirrhosis is an independent risk factor for progression to both HD and ACLF. High model for end-stage liver disease score, high aspartate aminotransferase, and low prothrombin activity are associated with progression to ACLF.