Prospective Study
Copyright ©The Author(s) 2018.
World J Gastroenterol. Jun 7, 2018; 24(21): 2300-2310
Published online Jun 7, 2018. doi: 10.3748/wjg.v24.i21.2300
Table 1 Baseline characteristics of hepatitis B virus-related acute-on-chronic liver failure and hepatitis B virus-related decompensated cirrhosis patients categorized according to the presence of acute kidney injury
CharacteristicsHBV-DC
HBV-ACLF
P valueaP valueb
DC-non-AKI (n = 104)DC-AKI (n = 28)ACLF-non-AKI (n = 209)ACLF-AKI (n = 71)
Age (yr)151.4 ± 1.058.1 ± 2.244.2 ± 0.849.3 ± 1.30.002< 0.001
Male (%)389 (85.6)17 (60.7)189 (90.4)65 (91.5)0.002< 0.001
Cirrhosis (%)3104 (100)28 (100)87 (41.6)34 (47.9)< 0.001< 0.001
Complications
Ascites (%)373 (70.2)27 (96.4)127 (60.8)58 (81.7)0.105< 0.001
HE (%)36 (5.8)1 (3.6)13 (6.2)14 (19.7)0.060.006
GI bleeding (%)38 (7.7)4 (14.3)2 (1)3 (4.2)0.0970.001
SBP (%)313 (12.5)17 (60.7)28 (13.4)41 (57.7)0.787< 0.001
Pulmonary infection (%)311 (10.6)8 (28.6)14 (6.7)23 (32.4)0.638< 0.001
Diabetes (%)310 (9.6)3 (10.7)17 (8.1)10 (14.1)10.492
Hypertension (%)36 (5.7)4 (14.3)13 (6.2)8 (11.3)0.736< 0.212
Clinical and laboratory data
ALT (U/L)240.5 (22-82)33.5 (21-59.5)134 (70.5-302)136 (60.5-253.5)< 0.001< 0.001
AST (U/L)256 (39.3-88.7)61 (39.5-104)119 (78.5-207)146 (62-277.5)< 0.001< 0.001
ALP (U/L)2103 (82.3-137.8)97 (70.8-120)132 (110-162)129 (101.5-155)0.001< 0.001
Serum bilirubin (mg/dL)22.8 (1.3-5.3)4.1 (1.7-8.0)17.5 (11.2-25)25.7 (18.4-34)< 0.001< 0.001
Serum albumin (g/L)231.3 (27.05-34.4)28.6 (24.1-33.7)31.8 (29.2-34.4)31.5 (28.7-34.6)0.023< 0.057
Serum creatinine (mg/dL)20.78 (0.68-0.87)0.97 (0.81-1.23)0.68 (0.6-0.81)0.94 (0.74-1.26)0.665< 0.001
BUN (mmol/L)24.0 (3.3-5.2)12.8 (8.0-17.8)3.5 (2.8-4.3)11.2 (8.2-18)0.905< 0.001
eGFR (mL/min/1.73 m2)2104 (92.8-115.1)45.9 (40-59.5)113.9 (102.8-124.7)42.7 (27.4-58.5)0.164< 0.001
Serum sodium (mmol/L)2138.5 (134.7-141)135.4 (133.2-138.4)137.3 (134.7-139.4)130 (126.4-133.9)0.001< 0.001
Serum potassium (mmol/L)24.0 (3.6-4.3)3.9 (3.4-4.3)4.1 (3.6-4.4)3.6 (3.1-4.5)0.487< 0.001
INR21.45 (1.28-1.81)1.65 (1.48-2.14)1.89 (1.6-2.65)2.81 (1.98-3.86)< 0.001< 0.001
Leukocyte count (× 109/L)23.6 (2.5-5.0)4.1 (3.1-6.6)5.9 (4.4-8.4)10.0 (6.0-13.3)< 0.001< 0.001
PLT (× 109/L)261.3 (45.3-104.8)67.5 (39.3-89.3)95.2 (64.5-140.5)79 (47-115.5)0.058< 0.001
Hemoglobin (g/L)2114 (94.5-126)95.5 (75.75-112)123 (107.5-136)115 (100.5-131.5)< 0.001< 0.001
MAP (mmHg)182.9 ± 1.175.9 ± 1.586.7 ± 0.776.7 ± 1.10.921< 0.001
HBV-DNA (log10)24.5 (2.7-6.3)4.1 (2.8-6.1)5.4 (3.7-7.1)5.3 (3.5-7.2)0.0430.013
Child-Pugh score29 (7-11)11 (8-12)11 (9-12)12 (11-13)0.061< 0.001
MELD score213 (8.1-16)19.7 (16.2-25.3)21.2 (19-25)34.5 (29.2-41.6)< 0.001< 0.001
1Means ± SD, compared by Student’s t test or one-way ANOVA test;
2Median (IQR), compared by Mann-Whitney U test or Kruskal-Wallis test;
3Number (percentage), compared by fisher's exact test or chi-square test;
aDC-AKI group vs ACLF-AKI group;
bCompared among all groups. SD: Standard deviation; IQR: Inter-quartile range; DC: Decompensated chirrhosis; ACLF: Acute-on-chronic liver failure; AKI: Acute kidney injury; HE: Hepatic encephalopathy; GI: Gastrointestinal; SBP: Spontaneous bacterial peritonitis; ALT: Alanine amino transaminases; AST: Aspartate transaminases; ALP: Alkaline phosphate; BUN: Blood urea nitrogen; eGFR: Estimated glomerular filtration rate; INR: International normalized ratio; MAP: Mean arterial pressure; MELD: Model of end-stage liver disease score.
Table 2 Clinical characteristics of hepatitis B virus-related acute-on-chronic liver failure and hepatitis B virus-related decompensated cirrhosis patients after enrollment
CharacteristicsHBV-DC
HBV-ACLF
P valueaP valueb
DC-non-AKI (n = 104)DC-AKI (n = 28)ACLF-non-AKI (n = 209)ACLF-AKI (n = 71)
Hospitalization (d)113 (8-20)12.5 (9-18.3)26 (17-43)16 (10.5-33)0.144< 0.001
Complications
Ascites (%)280 (76.9)28 (100)141 (67.5)67 (94.4)0.570< 0.001
HE (%)28 (7.7)3 (10.7)41 (19.6)31 (43.7)< 0.001< 0.001
GI bleeding (%)211 (10.6)5 (17.9)5 (2.4)6 (8.5)0.1510.002
SBP (%)222 (21.2)19 (67.9)68 (32.5)47 (66.2)0.872< 0.001
Pulmonary infection (%)220 (19.2)8 (28.6)43 (20.6)23 (32.4)0.9440.134
Serum creatinine (mg/dL)1
Baseline0.78 (0.68-0.87)0.97 (0.81-1.23)0.68 (0.6-0.81)0.94 (0.74-1.26)0.665< 0.001
Peak0.84 (0.74-0.96)1.69 (1.44-2.07)0.83 (0.7-0.94)1.99 (1.63-2.57)0.028< 0.001
Final0.76 (0.66-0.87)1.05 (0.77-1.48)0.74 (0.64-0.85)1.48 (0.98-2.32)0.014< 0.001
Treated with terlipressin (%)2-19 (67.9)-43 (60.6)0.499-
Treatment time1-5 (3-9)-6 (3-9)0.023-
30-d mortality27 (6.7)9 (32.1)38 (18.2)42 (59.2)0.015< 0.001
90-d mortality210 (9.6)14 (50)69 (33)51 (71.8)0.039< 0.001
1Median (IQR), compared by Mann-Whitney U test or Kruskal–Wallis test;
2Number (percentage), compared by fisher's exact test or chi-square test;
aDC-AKI group vs ACLF-AKI group;
bCompared among all groups. SD: Standard deviation; IQR: Inter-quartile range; HE: Hepatic encephalopathy; GI: Gastrointestinal; SBP: Spontaneous bacterial peritonitis.
Table 3 Univariate and multivariate logistics regression analysis to assess factors associated with the response to terlipressin treatment
VariablesUnivariate analysis
Multivariate analysis
OR (95%CI)P valueOR (95%CI)P value
Age1.024 (0.975-1.075)0.344
Gender0.35 (0.090-1.357)0.129
Grouping (DC/ACLF)0.282 (0.087-0.913)0.0350.282 (0.087-0.913)0.035
Baseline serum creatinine1.074 (0.417-2.77)0.882
Peak serum creatinine0.499 (0.268-0.930)0.029
Cirrhosis1.50 (0.513-4.385)0.459
HE0.318 (0.103-0.981)0.046-0.148
GI bleeding1.091 (0.262-4.537)0.905
Ascites0.735 (0.044-12.330)0.831
SBP0.452 (0.125-1.633)0.226
Pulmonary infection0.970 (0.324-2.904)0.956
ALT0.997 (0.993-1.001)0.153
AST0.997 (0.993-1.002)0.095
Serum albumin0.986 (0.895-1.1087)0.782
Serumbilirubin0.956 (0.917-0.996)0.032
Serum sodium1.071 (0.986-1.163)0.103
INR0.462 (0.260-0.823)0.009
Leukocyte count0.903 (0.816-0.999)0.048-0.180
MAP0.998 (0.937-1.062)0.944
Child-Pugh score0.809 (0.608-1.076)0.146
MELD0.921 (0.870-0.975)0.004
Treatment time1.020 (0.978-1.065)0.352
DC: Decompensated chirrhosis; ACLF: Acute-on-chronic liver failure; HE: Hepatic encephalopathy; GI: Gastrointestinal; SBP: Spontaneous bacterial peritonitis; ALT: Alanine amino transaminases; AST: Aspartate transaminases; INR: International normalized ratio; MAP: Mean arterial pressure; MELD: Model of end-stage liver disease score.
Table 4 Cox proportional-hazards model to assess the 90 d death risk
Variables90-d mortality
HR (95%CI)P value
Age1.022 (1.005-1.039)0.010
Ascite2.120 (1.075-4.178)0.030
HE5.342 (3.654-7.808)< 0.001
DC without AKIReference-
ACLF without AKI3.449 (1.684-7.064)10.001
DC with AKI4.674 (1.977-10.943)1< 0.001
ACLF with AKI7.986 (3.823-16.683)1< 0.001
1The death risk of patients with DC without AKI were set as reference, HR were adjusted by age, presence of ascites, HE, SBP and leukocyte count. HR: Hazards ratio; HE: Hepatic encephalopathy; SBP: Spontaneous bacterial peritonitis; DC: Decompensated chirrhosis; ACLF: Acute-on -chronic liver failure; AKI: Acute kidney injury.