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Progress in hepatitis B virus-related acute-on-chronic liver failure treatment in China: A large, multicenter,
Lan-Lan Xiao1, Xiao-Xin Wu1, Jia-Jia Chen1
1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, Zhejiang University, Hangzhou 310003, China.
Insights
Treatment for Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) has improved over the last decade. Survival rates increased significantly with artificial liver support systems (ALSS) and nucleos(t)ide analog use in recent cohorts.
Area of Science:
- Hepatology
- Viral Hepatitis
- Liver Failure Management
Background:
- Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) presents a critical clinical challenge with high short-term mortality.
- Characterizing treatment advancements for HBV-ACLF in China over the past decade is essential for understanding survival improvements.
Purpose of the Study:
- To evaluate the efficacy of treatment strategies for HBV-ACLF over a ten-year period.
- To determine if advancements in HBV-ACLF care have led to improved patient outcomes.
Main Methods:
- Retrospective comparison of two nationwide cohorts (2008-2011 and 2012-2015) of HBV-ACLF patients.
- Analysis of survival rates between standard medical therapy (SMT) and artificial liver support system (ALSS) groups, utilizing propensity score matching.
- Multivariate logistic regression to identify independent factors influencing 28-day survival.
Main Results:
- Short-term survival rates (28/56 days) were significantly higher in the ALSS group compared to the SMT group (P < 0.05).
- Cohort II (2012-2015) demonstrated significantly higher survival rates than Cohort I (2008-2011) for both SMT and ALSS treatments (P < 0.001).
- Independent factors for improved 28-day survival included ALSS, nucleos(t)ide analogs, and albumin levels, while older age, total bilirubin, INR, and COSSH-ACLF grade were associated with increased mortality.
Conclusions:
- Treatment for HBV-ACLF has demonstrably improved over the past decade in China.
- The adoption of artificial liver support systems and nucleos(t)ide analogs has contributed to enhanced patient survival.
Background:
Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) has a high short-term mortality. However, the treatment progression for HBV-ACLF in China in the past decade has not been well characterized. The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.
Methods:
This study retrospectively compared short-term (28/56 days) survival rates of two different nationwide cohorts (cohort I: 2008-2011 and cohort II: 2012-2015). Eligible HBV-ACLF patients were enrolled retrospectively. Patients in the cohorts I and II were assigned either to the standard medical therapy (SMT) group (cohort I-SMT, cohort II-SMT) or artificial liver support system (ALSS) group (cohort I-ALSS, cohort II-ALSS). Propensity score matching analysis was conducted to eliminate baseline differences, and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.
Results:
Short-term (28/56 days) survival rates were significantly higher in the ALSS group than those in the SMT group (P < 0.05) and were higher in the cohort II than those in the cohort I (P < 0.001). After propensity score matching, short-term (28/56 days) survival rates were higher in the cohort II than those in the cohort I for both SMT (60.7% vs. 53.0%, 50.0% vs. 39.8%, P < 0.05) and ALSS (66.1% vs. 56.5%, 53.0% vs. 44.4%, P < 0.05) treatments. The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments (P = 0.046). Multivariate logistic regression analysis revealed that ALSS (OR = 0.962, 95% CI: 0.951-0.973, P = 0.038), nucleos(t)ide analogs (OR = 0.927, 95% CI: 0.871-0.983, P = 0.046), old age (OR = 1.028, 95% CI: 1.015-1.041, P < 0.001), total bilirubin (OR = 1.002, 95% CI: 1.001-1.003, P = 0.004), INR (OR = 1.569, 95% CI: 1.044-2.358, P < 0.001), COSSH-ACLF grade (OR = 2.683, 95% CI: 1.792-4.017, P < 0.001), and albumin (OR = 0.952, 95% CI: 0.924-0.982, P = 0.002) were independent factors for 28-day mortality.
Conclusions:
The treatment for patients with HBV-ACLF has improved in the past decade.
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