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Published on: February 19, 2019
[Diagnostic criteria for HBV-related acute-on-chronic pre-liver failure]
1Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.
Insights
New diagnostic criteria for pre-acute-on-chronic liver failure (pre-ACLF) in HBV infection effectively predict liver failure risk. These criteria, along with a predictive model, aid in early risk assessment for patients with severe hepatitis B.
Area of Science:
- Hepatology
- Viral Hepatitis
- Liver Failure Prediction
Background:
- Hepatitis B virus (HBV) infection can lead to acute-on-chronic liver failure (ACLF).
- Early identification of patients at high risk for ACLF is crucial for timely intervention.
- Existing diagnostic criteria for pre-ACLF require refinement for better prediction accuracy.
Purpose of the Study:
- To establish effective diagnostic criteria for HBV-related pre-ACLF.
- To develop a predictive model for assessing the risk of developing ACLF in patients with severe chronic hepatitis B.
Main Methods:
- A cohort of 1279 patients with severe icteric chronic hepatitis B (CHB) and/or acute exacerbation of CHB was analyzed.
- Serum levels of ALT, AST, TBil, and INR, along with age and sex, were assessed for their influence on ACLF incidence.
- Multivariate logistic regression was employed to develop diagnostic criteria and a predictive model for ACLF.
Main Results:
- Serum ALT, AST, TBil, and INR were identified as independent risk factors for liver failure.
- Diagnostic criteria for pre-ACLF include INR ≥ 1.30 or AST ≥ 10×ULN with jaundice, or TBil ≥ 342.0 μmol/L.
- A predictive model incorporating AST, TBil, INR, and age demonstrated significant correlation with ACLF incidence.
Conclusions:
- The developed diagnostic criteria for pre-ACLF offer effective prediction of liver failure risk in HBV-infected patients.
- The predictive model provides a valuable tool for quantifying ACLF risk, aiding clinical decision-making.
Objective:
To investigate the diagnostic criteria for HBV-related acute-on-chronic pre-liver failure (pre-ACLF) which can effectively predict the risk of liver failure.
Methods:
A total of 1279 patients with severe icteric chronic hepatitis B (CHB) and/or severe acute exacerbation of CHB were enrolled. The influence of serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBil), international normalized ratio (INR) of prothrombin time, sex, and age on the incidence rate of acute-on-chronic liver failure (ACLF) was analyzed, the diagnostic criteria for pre-ACLF and predictive model for ACLF were developed. The chi-square test was used for comparison of categorical variables, and the independent samples t-test was used for continuous data; multivariate logistic regression analysis was performed to evaluate the risk of liver failure.
Results:
The baseline serum levels of ALT, AST, and TBil, and INR were independent risk factors for liver failure (P < 0.05). The diagnostic criteria for pre-ACLF were as follows: (1) INR≥1.30; (2) AST≥10×upper limit of normal (ULN) and obvious jaundice (TBil≥51.3 μmol/L), or TBil≥342.0 μmol/L. These criteria had a positive predictive value of 45.9%, a negative predictive value of 89.8%, a sensitivity of 69.1%, and a specificity of 76.9%. The predictive model for the risk of ACLF was PY = 1=e(X)/(1+e(X)) (PY represented positive results of logistic regression analysis), X = -10.245+0.026×AST(ULN)-0.025×AST(ULN)+0.046×TBil(mg/dl) + 4.642×INR+0.049×age(years). The patients with higher PY values tended to have a higher incidence rate of ACLF. The incidence rate of ACLF was 75.3% in patients with PY≥0.60, more than 50% in patients with a PY value of 0.40-0.59, and 1.8% in patients with PY < 0.10 (P < 0.01).
Conclusion:
The diagnostic criteria for pre-ACLF and predictive model can effectively evaluate the risk of HBV-related ACLF.
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