J Dig Dis. 2018 Sep 17. doi: 10.1111/1751-2980.12671. [Epub ahead of print]
ACLF does exist in HBV-related decompensated cirrhotic patients.
Wang SJ1, Yin S1, Gu WY1, Zhang Y1, Li H1.
Author information
1
Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai, China.
Abstract
OBJECTIVE:
Acute-on-chronic liver failure (ACLF) may develop from compensated cirrhotic patients with acute decompensation (AD) which was demonstrated in both alcoholic and HBV-related cohorts. However, there is a type of ACLF developing from decompensated cirrhotic patients with AD in alcoholic cirrhosis, which is not certain in Asia-HBV high epidemic area. This research focused to verify whether ACLF can develop from patients with previous decompensation in an HBV-related cohort and identified the homogeneity between these hypothetical ACLF patients and the ACLF that developed from compensated cirrhosis.
METHODS:
Patients with HBV-related cirrhosis and AD were screened and 890 cases were enrolled. 400 cases were with first AD and 157 cases in them were diagnosed with ACLF within 28-days after admission according to EASL-CLIF criteria. Other 490 cases had previous decompensation history and 143 cases in them met the ACLF criteria. The 28-day mortalities, characteristics and important laboratory data changes during hospitalization such as total bilirubin, creatinine, white blood cell counts and MELD score were compared between ACLF patients and the 143 hypothetical ACLF patients.
RESULTS:
The 28-day mortality of 143 hypothetical ACLF patients with previous decompensation had no significant difference with ACLF patients with first AD. The WBC, serum bilirubin, serum creatinine, INR and MELD score exhibited similar variation tendencies in two groups at day1, day7 and day28/discharge/death. And these data in the two groups showed significant difference with the non-ACLF patients.
CONCLUSION:
HBV-related cirrhotic patients with previous decompensation who were diagnosed with ACLF were homogeneous with ACLF developing from compensated cirrhosis. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS:
acute decompensation; acute-on-chronic liver failure; hepatitis B virus; liver cirrhosis