Liver Research Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, England.
Liver Int. 2019 May;39(5):854-860. doi: 10.1111/liv.14072. Epub 2019 Mar 8.
The long-term outcomes of patients with hepatitis B virus-related acute on chronic liver failure (HBV-ACLF) remain unclear. The main aim of the study was to compare the 5-year survival rate and incidence rate of hepatocellular carcinoma (HCC) between patients with HBV-ACLF and HBV-cirrhosis.
Clinical data of patients with ACLF, compensated cirrhosis and decompensated cirrhosis who survived more than 3 months after diagnosis were collected. The survival rate and cumulative incidence of HCC were compared. The Cox regression was used to evaluate risk factors for outcomes.
A total of 814 patients were included in the analysis, including 122 (14.99%) patients with ACLF, 450 (55.28%) patients with compensated cirrhosis and 242 (29.73%) patients with decompensated cirrhosis. The 5-year survival rate of patients with ACLF (97.2%) was higher than patients with decompensated cirrhosis (86.0%), but was lower than patients with compensated cirrhosis (99.1%). The 5-year HCC incidence rate was the highest in the decompensated cirrhosis group (14.6%, P < 0.05), while no statistical differences were found between patients with ACLF (3.5%) and compensated cirrhosis (9.5%). The episode of ACLF did not increase the risk of HCC and the overall survival when compared with patients with cirrhosis. In ACLF subgroup analysis, the age, rather than the presence of cirrhosis, was independently associated with both mortality and incidence of HCC.
ACLF patients who survived the first 3 months had a better long-term prognosis than decompensated cirrhosis, while the HCC risk was comparable to compensated cirrhosis. HCC surveillance is strongly recommended for these patients.
乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者的长期预后仍不清楚。本研究的主要目的是比较 HBV-ACLF 患者与 HBV 肝硬化患者的 5 年生存率和肝细胞癌（HCC）发生率。
收集诊断后存活超过 3 个月的 ACLF、代偿性肝硬化和失代偿性肝硬化患者的临床资料。比较生存率和 HCC 累积发生率。采用 Cox 回归评估预后的危险因素。
共纳入 814 例患者，其中 ACLF 患者 122 例（14.99%），代偿性肝硬化患者 450 例（55.28%），失代偿性肝硬化患者 242 例（29.73%）。ACLF 患者 5 年生存率（97.2%）高于失代偿性肝硬化患者（86.0%），但低于代偿性肝硬化患者（99.1%）。失代偿性肝硬化患者 5 年 HCC 发生率最高（14.6%，P<0.05），而 ACLF 患者（3.5%）与代偿性肝硬化患者（9.5%）之间无统计学差异。与肝硬化患者相比，ACLF 发作并未增加 HCC 风险和总体生存率。在 ACLF 亚组分析中，年龄而不是肝硬化的存在与死亡率和 HCC 发生率独立相关。
在存活前 3 个月的 ACLF 患者的长期预后优于失代偿性肝硬化，而 HCC 风险与代偿性肝硬化相当。强烈建议对这些患者进行 HCC 监测。
