Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 16, 2022; 10(23): 8186-8195
Published online Aug 16, 2022. doi: 10.12998/wjcc.v10.i23.8186
Short-term prognostic factors for hepatitis B virus-related acute-on-chronic liver failure
Qiao-Xia Ye, Jin-Fa Huang, Zheng-Ju Xu, Yan-Yan Yan, Yan Yan, Li-Guan Liu
Qiao-Xia Ye, Jin-Fa Huang, Zheng-Ju Xu, Yan-Yan Yan, Yan Yan, Li-Guan Liu, Department of Infectious Diseases, The 910th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Quanzhou 362000, Fujian Province, China
Author contributions: Ye QX and Huang JF wrote the manuscript; Xu ZJ and Yan YY collected the data; Yan Y and Liu LG analyzed the data.
Supported by Science and Technology Project of Quanzhou to Dr. Zhengju Xu, No. 2017Z018.
Institutional review board statement: The study was approved by the Ethics Committee of the 910th Hospital of Chinese People's Liberation Army (No. 32).
Informed consent statement: Informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All the data used to support the findings of this study are included within the article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li-Guan Liu, MD, Professor, Department of Infectious Diseases, The 910th Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, No. 180 Huayuan Road, Fengze District, Quanzhou 362000, Fujian Province, China. liuliguan8255@126.com
Received: January 24, 2022
Peer-review started: January 24, 2022
First decision: March 8, 2022
Revised: May 12, 2022
Accepted: July 11, 2022
Article in press: July 11, 2022
Published online: August 16, 2022
ARTICLE HIGHLIGHTS
Research background

Acute-on-chronic liver failure (ACLF) refers to a syndrome precipitated by sudden worsening of chronic liver disease, seen as severe acute jaundice, coagulopathy, and other manifestations of liver failure. The short-term mortality rate of ACLF is 50%-90%.

Research motivation

Early and accurate assessment of disease severity and short-term prognosis in patients with ACLF can help determine the timing of liver transplantation, which can significantly improve the survival rate of patients with ACLF.

Research objectives

To explore the independent predictors of short-term prognosis in patients with hepatitis B virus (HBV)-related ACLF and to establish a predictive short-term prognosis model for HBV-related ACLF.

Research methods

Patients were divided into either a survival group or a death group according to their survival 3 mo after diagnosis. Data of relevant observation indicators of patients were retrospectively collected and analyzed. After determining the influencing factors of short-term prognosis, a prognostic model was established based on binary logistics regression and the prediction value of this model was tested by comparing with selected classical prognostic models.

Research results

Univariate analysis showed significant differences in age, platelet count, total bilirubin, blood urea nitrogen, neutrophil-to-lymphocyte ratio, HBsAg, alpha-fetoprotein, Golgi protein 73 (GP73), international normalized ratio, stage of liver failure, classification of liver failure, and incidence of complications between the groups. In addition, GP73, stage of liver failure, pulmonary infection, hepatorenal syndrome, and HBsAg were independent risk factors for short-term prognosis in patients with HBV-related ACLF. The predictive efficacy of the GP73-ACLF score prognostic model was significantly better than those of both the Model for End-Stage Liver Disease (MELD) and MELD-Na score models.

Research conclusions

The GP73-ACLF model has good predictive value, while GP73, stage of liver disease, pulmonary infection, hepatorenal syndrome, and HBsAg are independent risk factors for short-term prognosis in patients with HBV-related ACLF.

Research perspectives

Combined with the King’s College Hospital Criteria, the low specificity of GP73-ACLF prognostic model can be greatly enhanced; this is worth verifying in subsequent studies.