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Original Article
Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure
  1. Tianzhou Wu1,
  2. Jiang Li1,
  3. Li Shao1,
  4. Jiaojiao Xin1,
  5. Longyan Jiang1,
  6. Qian Zhou1,
  7. Dongyan Shi1,
  8. Jing Jiang1,
  9. Suwan Sun1,
  10. Linfeng Jin1,
  11. Ping Ye1,
  12. Lingling Yang1,
  13. Yinyun Lu1,
  14. Tan Li1,
  15. Jianrong Huang1,
  16. Xiaowei Xu1,
  17. Jiajia Chen1,
  18. Shaorui Hao1,
  19. Yuemei Chen1,
  20. Shaojie Xin2,
  21. Zhiliang Gao3,
  22. Zhongping Duan4,
  23. Tao Han5,
  24. Yuming Wang6,
  25. Jianhe Gan7,
  26. Tingting Feng7,
  27. Chen Pan8,
  28. Yongping Chen9,
  29. Hai Li10,
  30. Yan Huang11,
  31. Qing Xie12,
  32. Shumei Lin13,
  33. Lanjuan Li1,
  34. Jun Li1
  35. on behalf of the Chinese Group on the Study of Severe Hepatitis B (COSSH).
  1. 1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
  2. 2Department of Liver and Infectious Diseases, No. 302 Hospital of Chinese People’s Liberation Army, Beijing, China
  3. 3Department of Liver and Infectious Diseases, The Third Affiliated Hospital, Sun YAT-SEN University, Guangzhou, China
  4. 4Department of Liver and Infectious Diseases, Beijing YouAn Hospital, Capital Medical University, Beijing, China
  5. 5Department of Liver and Infectious Diseases, Tianjin Third Central Hospital, Tianjin, China
  6. 6Department of Liver and Infectious Diseases, The First Hospital Affiliated of The Third Military Medical University, Chongqing, China
  7. 7Department of Liver and Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China
  8. 8Department of Liver and Infectious Diseases, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China
  9. 9Department of Liver and Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
  10. 10Department of Gastroenterology, Renji Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
  11. 11Department of Liver and Infectious Diseases, Xiangya Hospital Central South University, Changsha, China
  12. 12Department of Liver and Infectious Diseases, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
  13. 13Department of Liver and Infectious Diseases, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
  1. Correspondence to Professor Jun Li, Laboratory for Diagnosisand Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou,China; lijun2009{at}zju.edu.cn and Professor Lanjuan Li; ljli{at}zju.edu.cn

Abstract

Objective The definition of acute-on-chronic liver failure (ACLF) based on cirrhosis, irrespective of aetiology, remains controversial. This study aimed to clarify the clinicopathological characteristics of patients with hepatitis B virus-related ACLF (HBV-ACLF) in a prospective study and develop new diagnostic criteria and a prognostic score for such patients.

Design The clinical data from 1322 hospitalised patients with acute decompensation of cirrhosis or severe liver injury due to chronic hepatitis B (CHB) at 13 liver centres in China were used to develop new diagnostic and prognostic criteria.

Results Of the patients assessed using the Chronic Liver Failure Consortium criteria with the exception of cirrhosis, 391 patients with ACLF were identified: 92 with non-cirrhotic HBV-ACLF, 271 with cirrhotic HBV-ACLF and 28 with ACLF with cirrhosis caused by non-HBV aetiologies (non-HBV-ACLF). The short-term (28/90 days) mortality of the patients with HBV-ACLF were significantly higher than those of the patients with non-HBV-ACLF. Total bilirubin (TB) ≥12 mg/dL and an international normalised ratio (INR) ≥1.5 was proposed as an additional diagnostic indicator of HBV-ACLF, and 19.3% of patients with an HBV aetiology were additionally diagnosed with ACLF. The new prognostic score (0.741×INR+0.523×HBV-SOFA+0.026×age+0.003×TB) for short-term mortality was superior to five other scores based on both discovery and external validation studies.

Conclusions Regardless of the presence of cirrhosis, patients with CHB, TB ≥12 mg/dL and INR ≥1.5 should be diagnosed with ACLF. The new criteria diagnosed nearly 20% more patients with an HBV aetiology with ACLF, thus increasing their opportunity to receive timely intensive management.

  • Hepatitis B
  • Liver Failure
  • Liver Cirrhosis

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Footnotes

  • Contributors TW, JL and LS contributed equally. The study was designed by JL and supervised by JL and LL. The manuscript was written by JL, TW, JL and LS. The experiment and data analysis were performed by JL, TW, JL, LS, JX, LJ, QZ, DS, JJ, SS, LJ, PY, LY, YL, TL, JH, XX, JC, SH, YC, SX, ZG, ZD, TH, YW, JG, TF, CP, YC, HL, YH, QX and SL. All authors were involved in critical revision of manuscript.

  • Funding This work was supported by National S&T Major Project of China (2012ZX10002004-001, 2017ZX10304402-002-002), National Natural Science Foundation of China (81571818/81771996) and Zhejiang Provincial and State’s Key Project of Research and Development Plan of China (2016YFC1101303/4, 2016C01G2010737).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Clinical Research Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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