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HBV-related acute-on-chronic liver failure with underlying chronic hepatitis has superior survival compared to

Xiaohui Liu1, Jing Zhang1, Xinhuan Wei1

  • 1The Third Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, People's Republic of China.

European Journal of Gastroenterology & Hepatology
|June 30, 2021
PubMed

Insights

Acute-on-chronic liver failure (ACLF) in non-cirrhotic hepatitis B patients showed better outcomes than in those with compensated cirrhosis. Type A ACLF had lower mortality and fewer organ failures than Type B ACLF.

Area of Science:

  • Hepatology
  • Internal Medicine
  • Critical Care Medicine

Background:

  • Acute-on-chronic liver failure (ACLF) is classified into three types based on underlying liver disease: non-cirrhosis (Type A), compensated cirrhosis (Type B), and decompensated cirrhosis (Type C).
  • The impact of underlying chronic liver disease on ACLF prognosis remains unclear.
  • This study compares characteristics and outcomes of Type A and Type B hepatitis B virus (HBV)-ACLF.

Purpose of the Study:

  • To compare the clinical characteristics and prognosis of Type A (non-cirrhosis) and Type B (compensated cirrhosis) HBV-ACLF.
  • To identify prognostic factors influencing outcomes in HBV-ACLF patients.

Main Methods:

  • Prospective enrollment of 86 Type A and 71 Type B HBV-ACLF patients based on EASL-CLIF criteria.
  • Evaluation of demography, laboratory data, organ failures, ACLF grades, and prognosis.
  • Univariate and multivariate Cox regression analyses to determine prognostic factors.

Main Results:

  • Type A ACLF exhibited significantly lower 28-day (20.9% vs. 60.6%) and 90-day (34.9% vs. 73.2%) mortality rates compared to Type B ACLF (P < 0.001).
  • Type A patients were younger with higher viral load, liver enzymes, and platelet counts, but had less ascites and lower severity scores.
  • Type B ACLF showed higher rates of renal and cerebral failure; cirrhosis was an independent negative prognostic factor (HR 2.4).

Conclusions:

  • ACLF in non-cirrhotic chronic hepatitis B (Type A) presents with more severe liver inflammation but fewer extrahepatic organ failures and a better prognosis than ACLF in compensated HBV cirrhosis (Type B).
  • Cirrhosis is a significant independent risk factor for mortality in HBV-ACLF.
Abstract

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