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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

Repeated measurements of Model for End-Stage Liver Disease (MELD) scores at 3-day intervals in the Favorable prognosis group (A) and the Unfavorable prognosis group (B) revealed wide and overlapping distributions.
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Figure 2: Repeated measurements of Model for End-Stage Liver Disease (MELD) scores at 3-day intervals in the Favorable prognosis group (A) and the Unfavorable prognosis group (B) revealed wide and overlapping distributions.

Mentions: Although the mean initial MELD score of the UFG was higher than that of the FG, initial MELD scores showed diffuse overlapped distribution in both groups. We measured the MELD scores of enrolled patients at 3-day intervals (Fig. 2). The serial mean MELD scores were similar at about 24 in the FG. On the other hand, a slight increase in the serial mean MELD scores was noted in the UFG. However, there were some missing serial MELD scores in both groups. Therefore, we compared the changes in subsequent MELD scores during hospitalization using a linear mixed model. There was a significant interaction effect between time and group in the MELD score changes between the FG and UFG (P=0.001). The mean MELD scores predicted by the linear mixed model are shown in Fig. 3. The predicted scores decreased over time in the FG, but increased continuously in the UFG. We used the paired t-test to estimate the changes in mean MELD scores between day 1 and subsequent days to obtain the delta MELD score. The numbers on the bar in Fig. 3 indicate the delta MELD score, the P-value from the paired t-test and the number of included patients. In FG, there was a significant decrease in the MELD score starting from the 7th day of hospitalization. The decrease in delta MELD score was -1.9 on the 7th day (P=0.016), -2.6 on the 10th day (P=0.005), and -2.7 on the 13th day (P=0.023). In UFG, a significant increase in delta MELD score appeared on the 7th day with an increase of 3 (P=0.010), followed by an increase of 4.8 on the 10th day (P=0.000), and 5.5 on the 13th day (P<0.001).


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)

Repeated measurements of Model for End-Stage Liver Disease (MELD) scores at 3-day intervals in the Favorable prognosis group (A) and the Unfavorable prognosis group (B) revealed wide and overlapping distributions.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Repeated measurements of Model for End-Stage Liver Disease (MELD) scores at 3-day intervals in the Favorable prognosis group (A) and the Unfavorable prognosis group (B) revealed wide and overlapping distributions.
Mentions: Although the mean initial MELD score of the UFG was higher than that of the FG, initial MELD scores showed diffuse overlapped distribution in both groups. We measured the MELD scores of enrolled patients at 3-day intervals (Fig. 2). The serial mean MELD scores were similar at about 24 in the FG. On the other hand, a slight increase in the serial mean MELD scores was noted in the UFG. However, there were some missing serial MELD scores in both groups. Therefore, we compared the changes in subsequent MELD scores during hospitalization using a linear mixed model. There was a significant interaction effect between time and group in the MELD score changes between the FG and UFG (P=0.001). The mean MELD scores predicted by the linear mixed model are shown in Fig. 3. The predicted scores decreased over time in the FG, but increased continuously in the UFG. We used the paired t-test to estimate the changes in mean MELD scores between day 1 and subsequent days to obtain the delta MELD score. The numbers on the bar in Fig. 3 indicate the delta MELD score, the P-value from the paired t-test and the number of included patients. In FG, there was a significant decrease in the MELD score starting from the 7th day of hospitalization. The decrease in delta MELD score was -1.9 on the 7th day (P=0.016), -2.6 on the 10th day (P=0.005), and -2.7 on the 13th day (P=0.023). In UFG, a significant increase in delta MELD score appeared on the 7th day with an increase of 3 (P=0.010), followed by an increase of 4.8 on the 10th day (P=0.000), and 5.5 on the 13th day (P<0.001).

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