Published online Nov 14, 2015. doi: 10.3748/wjg.v21.i42.11964
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
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.
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.