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Static and dynamic prognostic factors for hepatitis-B-related acute-on-chronic liver failure.

Ha JM, Sohn W, Cho JY, Pyo JH, Choi K, Sinn DH, Gwak GY, Choi MS, Lee JH, Koh KC, Paik SW, Yoo BC, Paik YH - Clin Mol Hepatol (2015)

Bottom Line: We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals.A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (≥28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (≥grade III) (OR=15.41, P=0.013).Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P=0.016).

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: Hepatitis-B-related acute-on-chronic liver failure has a poor prognosis. However, the advent of potent oral antiviral agents means that some patients can now recover with medical treatment. We aimed to identify the prognostic factors for hepatitis-B-related acute-on-chronic liver failure including the initial as well as the dynamically changing clinical parameters during admission.

Methods: Sixty-seven patients were retrospectively enrolled from 2003 to 2012 at Samsung Medical Center. The patients were classified into three categories: Recovery group (n=23), Liver transplantation group (n=28), and Death group (n=16). The Liver transplantation and Death groups were combined into an Unfavorable prognosis group. We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals.

Results: A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (≥28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (≥grade III) (OR=15.41, P=0.013). Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P=0.016).

Conclusions: Dynamic changes in clinical parameters during admission are useful prognostic factors for hepatitis-B-related acute-on-chronic liver failure.

No MeSH data available.


Related in: MedlinePlus

Study design for enrollment and classification of patients with hepatitis-B-related acute-on-chronic liver failure according to outcome.
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Figure 1: Study design for enrollment and classification of patients with hepatitis-B-related acute-on-chronic liver failure according to outcome.

Mentions: We retrospectively enrolled a total of 141 patients with ACLF in CHB who had been hospitalized at Samsung Medical Center, Seoul, Korea between January 2003 and December 2012. Of these patients, we excluded 74 with the following conditions: 6 patients superinfected with other hepatotropic viruses (hepatitis A [n=5] and hepatitis C [n=1]), 13 patients with combined etiologies of acute liver injury (alcohol (n=4), hepatotoxic drugs including medicinal herbs (n=3), sepsis-related liver injury (n=5), and cryptogenic causes (n=1)), 55 patients with coexistent malignancy (hepatocellular carcinoma (n=54) and esophageal cancer (n=1)). Consequently, 67 patients were analyzed in this study (Fig. 1).


Static and dynamic prognostic factors for hepatitis-B-related acute-on-chronic liver failure.

Ha JM, Sohn W, Cho JY, Pyo JH, Choi K, Sinn DH, Gwak GY, Choi MS, Lee JH, Koh KC, Paik SW, Yoo BC, Paik YH - Clin Mol Hepatol (2015)

Study design for enrollment and classification of patients with hepatitis-B-related acute-on-chronic liver failure according to outcome.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4612284&req=5

Figure 1: Study design for enrollment and classification of patients with hepatitis-B-related acute-on-chronic liver failure according to outcome.
Mentions: We retrospectively enrolled a total of 141 patients with ACLF in CHB who had been hospitalized at Samsung Medical Center, Seoul, Korea between January 2003 and December 2012. Of these patients, we excluded 74 with the following conditions: 6 patients superinfected with other hepatotropic viruses (hepatitis A [n=5] and hepatitis C [n=1]), 13 patients with combined etiologies of acute liver injury (alcohol (n=4), hepatotoxic drugs including medicinal herbs (n=3), sepsis-related liver injury (n=5), and cryptogenic causes (n=1)), 55 patients with coexistent malignancy (hepatocellular carcinoma (n=54) and esophageal cancer (n=1)). Consequently, 67 patients were analyzed in this study (Fig. 1).

Bottom Line: We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals.A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (≥28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (≥grade III) (OR=15.41, P=0.013).Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P=0.016).

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: Hepatitis-B-related acute-on-chronic liver failure has a poor prognosis. However, the advent of potent oral antiviral agents means that some patients can now recover with medical treatment. We aimed to identify the prognostic factors for hepatitis-B-related acute-on-chronic liver failure including the initial as well as the dynamically changing clinical parameters during admission.

Methods: Sixty-seven patients were retrospectively enrolled from 2003 to 2012 at Samsung Medical Center. The patients were classified into three categories: Recovery group (n=23), Liver transplantation group (n=28), and Death group (n=16). The Liver transplantation and Death groups were combined into an Unfavorable prognosis group. We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals.

Results: A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (≥28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (≥grade III) (OR=15.41, P=0.013). Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P=0.016).

Conclusions: Dynamic changes in clinical parameters during admission are useful prognostic factors for hepatitis-B-related acute-on-chronic liver failure.

No MeSH data available.


Related in: MedlinePlus