Risk factors for progression to acute-on-chronic liver failure during severe acute exacerbation of chronic hepatitis B virus infection

doi:10.3748/wjg.v25.i19.2327

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World Journal of Gastroenterology

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World J Gastroenterol. May 21, 2019; 25(19): 2327-2337
Published online May 21, 2019. doi: 10.3748/wjg.v25.i19.2327

Table 1 Baseline characteristics of patients with and without post-admission progression to hepatic decompensation

Variable	Total (n = 135)	Patients		P-value
Variable	Total (n = 135)	Without progression to HD (n = 92)	With progression to HD (n = 43)	P-value
Males	120 (88.9)	82 (88.2)	38 (90.5)	0.777¹
Age (yr)	39.1 ± 10.6	36.6 ± 9.4	44.6 ± 11.2	0.000²
LC	62 (45.9)	20 (21.7)	42 (97.7)	0.000¹
HBeAg–positive	53 (39.3)	38 (40.9)	15 (35.7)	0.355¹
log HBV DNA (copies/mL)	6.7 (5.6, 7.5)	6.9 (5.9, 7.5)	6.3 (4.2, 7.2)	0.044³
Na+ (mmol/L)	137.0 ± 2.9	136.9 ± 3.0	136.9 ± 2.8	0.927²
ALT (IU/L)	680.0 (421.0, 1191.0)	838.0 (495.5, 1333.5)	469.0 (265.5, 725.5)	0.000³
AST (IU/L)	592.0 (313.0, 980.0)	636.0 (369.0, 1212.5)	502.5 (268.5, 760.0)	0.022³
GGT (IU/L)	145.0 (108.0, 223.0)	145.0 (110.5, 221.5)	145.5 (94.5, 225.0)	0.845³
CHE (IU/L)	3.9 ± 1.5	4.3 ± 1.4	3.2 ± 1.4	0.000²
TBil (μmol/L)	174.1 (96.1, 288.7)	153.7 (93.9, 283.5)	160.7 (88.8, 250.5)	0.932³
ALB (g/L)	33.6 ± 4.9	34.4 ± 4.2	31.6 ± 5.2	0.001²
PA (mg/L)	48.0 (35.0, 69.0)	54.4 ± 25.4	49.4 ± 30.5	0.329³
BUN (mmol/L)	3.9 (3.0, 4.6)	3.8 (2.9, 4.4)	4.5(3.3, 4.4)	0.010³
Cr (μmol/L)	74.0 (67.0, 83.0)	74.0 (67.0, 84.0)	73.0 (66.3, 82.0)	0.557³
INR	1.46 ± 0.18	1.45 ± 0.18	1.47 ± 0.16	0.510²
PTA (%)	51.9 ± 5.5	51.6 ± 5.5	52.9 ± 5.5	0.208²
WBC (10⁹/L)	5.2 (3.18, 6.7)	5.4 (3.9, 6.5)	4.7 (3.8, 7.5)	0.613³
PLT (10⁹/L)	120.2 ± 49.1	128.9 ± 49.5	100.9 ± 42.8	0.002²
MELD	17.5 ± 3.8	17.5 ± 3.9	17.3 ± 3.7	0.830²

Data are presented as the mean ± SD, n (%), or median (interquartile range).

¹Chi-square test results;

²t-test results;

³U test results. P-value: Patients with post-admission progression to hepatic decompensation vs patients without post-admission progression. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BUN: Urea nitrogen; CHE: Cholinesterase; Cr: Creatinine; GGT: Glutamine transpeptidase; HBeAg: Hepatitis B e-antigen; HD: Hepatic decompensation; INR: International standardization ratio; LC: Liver cirrhosis; MELD: Model for end-stage liver disease; Na⁺: Sodium; PA: Prealbumin; PLT: Platelet; PTA: Prothrombin activity; TBil: Total bilirubin; WBC: White blood cell.

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Table 2 Baseline characteristics of patients with and without post-admission progression to acute-on-chronic liver failure

Variable	Total (n = 164)	Patients		P-value
Variable	Total (n = 164)	Without progression to ACLF (n = 135)	With progression to ACLF (n = 29)	P-value
Males	143 (87.2)	120 (88.9)	23 (79.3)	0.216¹
Age (yr)	39.8 ± 10.1	39.1 ± 10.6	43.1 ± 11.1	0.066²
LC	83 (50.6)	62 (45.9)	21 (72.4)	0.013¹
HBeAg–positive	101 (61.6)	82 (60.7)	19 (65.5)	0.679¹
log HBV DNA (copies/mL)	6.7 (5.6, 7.5)	6.7 (5.5, 7.5)	7.1 (6.4, 7.7)	0.038³
Na+ (mmol/L)	137.0 ± 2.9	137.1 ± 2.7	137.7 ± 2.9	0.828²
ALT (IU/L)	724.5 (441.5, 1227.6)	680.0 (421.0, 1191.0)	833.0 (532.0, 1770.0)	0.056³
AST (IU/L)	628.0 (330.3, 1101.0)	592.0 (313.0, 980.0)	779.0 (426.5, 1411.0)	0.041³
GGT (IU/L)	139.5 (99.0, 210.8)	145.0 (108.0, 223.0)	111.0 (84.5, 162.5)	0.049³
CHE (IU/L)	4.0 ± 1.5	3.9 ± 1.5	4.1 ± 1.5	0.533²
TBil (μmol/L)	174.1 (96.1, 288.7)	155.1 (93.6, 272.9)	211.7 (147.3, 340.9)	0.038³
ALB (g/L)	33.5 ± 4.8	33.6 ± 4.8	33.3 ± 5.5	0.785²
PA (mg/L)	46.0 (31.3, 67.0)	48.0 (35.0, 69.0)	42.0 (26.5, 51.5)	0.041³
BUN (mmol/)	3.9 (3.0, 4.6)	3.9 (3.0, 4.6)	3.8 (3.2, 4.4)	0.923³
Cr (μmol/L)	73.0 (66.0, 82.0)	74.0 (67.0, 83.0)	71.0 (63.0, 77.5)	0.077³
INR	1.50 ± 0.21	1.46 ± 0.18	1.72 ± 0.24	0.000²
PTA (%)	51.1 (45.8, 55.8)	52.5 (48.1, 57.0)	44.0 (41.0, 47.8)	0.000³
WBC (10⁹/L)	5.4 (3.9, 6.8)	5.2 (3.18, 6.7)	5.7 (4.4, 6.8)	0.207³
PLT (10⁹/L)	118.9 ± 47.8	120.2 ± 49.1	112.5 ± 41.5	0.433²
MELD	17.9 ± 3.8	17.5 ± 3.8	19.8 ± 3.1	0.003²

Data are presented as the mean ± SD, n (%), or median (interquartile range).

¹Chi-square test results;

²t-test results;

³U test results. P-value: Patients with post-admission progression to acute-on-chronic liver failure vs patients without post-admission progression. ACLF: Acute-on-chronic liver failure; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BUN: Urea nitrogen; CHE: Cholinesterase; Cr: Creatinine; GGT: Glutamine transpeptidase; INR: International standardization ratio; LC: Liver cirrhosis; MELD: Model for end-stage liver disease; Na⁺: Sodium; PA: Prealbumin; PLT: Platelet; PTA: Prothrombin activity; TBil: Total bilirubin; WBC: White blood cell.

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Table 3 Univariate and multivariate analyses of risk factors associated with post-admission progression to hepatic decompensation

Variable	Univariate analysis				Multivariate analysis
Variable	Β	OR	95%CI	P-value	β	OR	95%CI	P-value
Age	0.077	1.080	1.038-1.123	0.000
HBV DNA	-0.276	0.759	0.587-0.981	0.035
ALT	-0.002	0.998	0.997-0.999	0.000	-0.003	0.997	0.995-1.000	0.038
AST	-0.001	0.999	0.998-1.000	0.015
CHE	-0.599	0.549	0.405-0.744	0.000
ALB	-0.140	0.869	0.796-0.948	0.002
BUN	0.238	1.268	1.029-1.563	0.026
PLT	-0.014	0.986	0.977-0.995	0.003
LC	5.019	151.2	19.6-1167.6	0.000	5.040	154.5	16.2-1469.0	0.000

CI: Confidence interval; OR: Odds ratio; ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; BUN: Urea nitrogen; CHE: Cholinesterase; HD: Hepatic decompensation; MELD: Model for end-stage liver disease; PLT: Platelet.

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Table 4 Univariate and multivariate analyses of risk factors associated with post-admission progression to acute-on-chronic liver failure

Variable	Univariate analysis				Multivariate analysis
Variable	Β	OR	95%CI	P-value	β	OR	95%CI	P-value
MELD	0.161	1.175	1.049-1.315	0.005	0.184	1.202	1.033-1.398	0.017
HBV DNA	0.380	1.463	1.018-2.101	0.040
AST	0.001	1.001	1.000-1.002	0.013	0.001	1.001	1.000-1.002	0.021
PTA	-0.252	0.777	0.704-0.858	0.000	-0.257	0.758	0.672-855	0.000
LC	1.128	3.091	1.280-7.465	0.012	2.125	8.369	2.389-29.322	0.001

ACLF: Acute-on-chronic liver failure; CI: Confidence interval; OR: Odds ratio; AST: Aspartate aminotransferase; LC: Liver cirrhosis; MELD: Model for end-stage liver disease; PTA: Prothrombin activity.

Full Size Table

Citation: Yuan L, Zeng BM, Liu LL, Ren Y, Yang YQ, Chu J, Li Y, Yang FW, He YH, Lin SD. Risk factors for progression to acute-on-chronic liver failure during severe acute exacerbation of chronic hepatitis B virus infection. World J Gastroenterol 2019; 25(19): 2327-2337
URL: https://www.wjgnet.com/1007-9327/full/v25/i19/2327.htm
DOI: https://dx.doi.org/10.3748/wjg.v25.i19.2327