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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2015; 21(42): 11964-11973
Published online Nov 14, 2015. doi: 10.3748/wjg.v21.i42.11964
Early warning and clinical outcome prediction of acute-on-chronic hepatitis B liver failure
En-Qiang Chen, Fan Zeng, Ling-Yun Zhou, Hong Tang
En-Qiang Chen, Fan Zeng, Hong Tang, Ling-Yu Zhou, Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
En-Qiang Chen, Fan Zeng, Ling-Yun Zhou, Hong Tang, Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Tang H designed the research and revised the manuscript; Chen EQ, Zeng F and Zhou LY searched and analyzed the literature; and Chen EQ wrote the manuscript.
Supported by National Natural Science Foundation of China, No. 81300319; and Science and Technology Support Program of Sichuan Province, China, No. 2015SZ0049.
Conflict-of-interest statement: The authors declared that there is no potential conflict of interest related to this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hong Tang, MD, Center of Infectious Diseases, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang, Wuhou District, Chengdu 610041, Sichuan Province, China. htang6198@hotmail.com
Telephone: +86-28-85422647 Fax: +86-28-85423052
Received: April 26, 2015
Peer-review started: April 27, 2015
First decision: July 13, 2015
Revised: July 29, 2015
Accepted: September 14, 2015
Article in press: September 14, 2015
Published online: November 14, 2015
Abstract

Hepatitis B virus (HBV) associated acute-on-chronic liver failure (ACLF) is an increasingly recognized fatal liver disease encompassing a severe acute exacerbation of liver function in patients with chronic hepatitis B (CHB). Despite the introduction of an artificial liver support system and antiviral therapy, the short-term prognosis of HBV-ACLF is still extremely poor unless emergency liver transplantation is performed. In such a situation, stopping or slowing the progression of CHB to ACLF at an early stage is the most effective way of reducing the morbidity and mortality of HBV-ACLF. It is well-known that the occurrence and progression of HBV-ACLF is associated with many factors, and the outcomes of HBV-ACLF patients can be significantly improved if timely and appropriate interventions are provided. In this review, we highlight recent developments in early warning and clinical outcome prediction in patients with HBV-ACLF and provide an outlook for future research in this field.

Keywords: Chronic hepatitis B, Acute exacerbation, Acute-on-chronic liver failure, Early warning, Clinical outcome prediction

Core tip: Acute-on-chronic liver failure (ACLF) is a devastating disease with very high short-term mortality in chronic hepatitis B (CHB) patients, and acute exacerbation of CHB is an inevitable stage in the development of hepatitis B virus (HBV)-ACLF. The use of various prognostic models, careful observation of dynamic changes in certain clinical manifestations, biochemical variables, immune cells, cytokines, chemokines, HBV genotype, and mutants can also provide important references to help physicians determine the timely diagnosis and effective treatment for patients with HBV-ACLF.