Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 28, 2012; 18(36): 5078-5083
Published online Sep 28, 2012. doi: 10.3748/wjg.v18.i36.5078
Predictors of the outcomes of acute-on-chronic hepatitis B liver failure
Hsiu-Lung Fan, Po-Sheng Yang, Hui-Wei Chen, Teng-Wei Chen, De-Chuan Chan, Chi-Hong Chu, Jyh-Cherng Yu, Shih-Ming Kuo, Chung-Bao Hsieh
Hsiu-Lung Fan, Teng-Wei Chen, De-Chuan Chan, Chi-Hong Chu, Jyh-Cherng Yu, Chung-Bao Hsieh, Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, China
Po-Sheng Yang, Division of General Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei 11490, Taiwan, China
Hui-Wei Chen, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, United States
Shih-Ming Kuo, Division of Pediatric Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan, China
Author contributions: Fan HL analyzed the data and wrote the paper; Yang PS collected the data at Mackay Memorial Hospital; Chen HW collected the data; Chen TW, Chan DC, Chu CH, Yu JC, and Kuo SM determined the direction of this manuscript; Hsieh CB designed the study.
Supported by Tri-Service General Hospital, No. TSGH-C101-137
Correspondence to: Chung-Bao Hsieh, Associate Professor, Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Sec. 2, Chen-Kung Rd, Neihu, Taipei 11490, Taiwan, China. albert0920@yahoo.com.tw
Telephone: +882-2-87923311 Fax: +882-2-87927372
Received: March 6, 2012
Revised: May 29, 2012
Accepted: June 8, 2012
Published online: September 28, 2012
Abstract

AIM: To identify the risk factors in predicting the outcome of acute-on-chronic hepatitis B liver failure patients.

METHODS: We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis B virus (ACLF-HBV) and without concurrent hepatitis C or D virus infection and hepatocellular carcinoma into two groups according to their outcomes after anti-HBV therapy. Their demographic, clinical, and biochemical data on the day of diagnosis and after the first week of treatment were analyzed using the Mann-Whitney U test, Fisher’s exact test, and a multiple logistic regression analysis.

RESULTS: The study included 113 patients (87 men and 26 women) with a mean age of 49.84 years. Fifty-two patients survived, and 61 patients died. Liver failure (85.2%), sepsis (34.4%), and multiple organ failure (39.3%) were the main causes of death. Multivariate analyses showed that Acute Physiology and Chronic Health Evaluation (APACHE) II scores ≥ 12 [odds ratio (OR) = 7.160, 95% CI: 2.834-18.092, P < 0.001] and positive blood culture (OR = 13.520, 95% CI: 2.740-66.721, P = 0.001) on the day of diagnosis and model for end-stage liver disease (MELD) scores ≥ 28 (OR = 8.182, 95% CI: 1.884-35.527, P = 0.005) after the first week of treatment were independent predictors of mortality.

CONCLUSION: APACHE II scores on the day of diagnosis and MELD scores after the first week of anti-HBV therapy are feasible predictors of outcome in ACLF-HBV patients.

Keywords: Lamivudine; Liver failure; Hepatitis B virus; Acute Physiology and Chronic Health Evaluation II score; Model for end-stage liver disease scores