Wang Xiao-Hua, Jiang Xue-Mei, Gao Pi-Xue, Liu Qian, Yuan Jun-Hua, Chen Shi-Jun
Departments of Infectious Diseases and Liver diseases, Jinan Infectious Disease Hospital, Shandong University.
School of Medicine, Shandong University.
Eur J Gastroenterol Hepatol. 2020 Feb;32(2):265-275. doi: 10.1097/MEG.0000000000001574.
To explore the risk factors and prognostic factors related to the acute-on-chronic liver failure (ACLF) occurrence and adverse outcome after withdrawal of nucleos(t)ide analogs (NAs) in chronic hepatitis B (CHB) patients.
Hospitalized CHB patients with relapse after NAs withdrawal at our medical center were retrospectively included in the present study from January 2011 to May 2018. Logistic regression, Cox regression analysis, Kaplan-Meier log-rank test, and area under the receiver operating characteristic curves (AUROC) were used.
A total of 389 CHB patients (including 46 ACLF patients) were included. Their median age was 48.0 years; 315 patients were male and 74 were female. The age ≥30 years and HBVDNA ≤1000 copies at admission in logistic regression were the independent risk factors for ACLF after NAs withdrawal in CHB patients. In patients who developed ACLF, only the model of end-stage liver disease combining serum natrium concentration (MELD-Na) score and relapse after Lamivudine (LAM) cessation in the Cox multivariate regression analysis were independent predictors for 12-week mortality. The artificial liver support system (ALSS) showed no improvement in the 12-week survival of ACLF patients. We further defined 22.35 as the optimal cutoff value of MELD-Na score to predict 12-week mortality for ACLF patients, with the AUROC of 0.817, a sensitivity of 76.5%, and a specificity of 75.9%.
The age ≥30 years and HBVDNA ≤1000 copies at admission strongly correlate with occurrence of ACLF, and higher MELD-Na score and relapse after LAM withdrawal are closely related with 12-week mortality among patients with ACLF after NAs withdrawal.
探讨慢性乙型肝炎（CHB）患者停用核苷（酸）类似物（NAs）后发生慢加急性肝衰竭（ACLF）及不良结局的危险因素和预后因素。
回顾性纳入2011年1月至2018年5月在我院医学中心因停用NAs后复发而住院的CHB患者。采用逻辑回归、Cox回归分析、Kaplan-Meier对数秩检验和受试者工作特征曲线下面积（AUROC）。
共纳入389例CHB患者（包括46例ACLF患者）。他们的中位年龄为48.0岁；男性315例，女性74例。逻辑回归分析显示，年龄≥30岁和入院时HBVDNA≤1000拷贝是CHB患者停用NAs后发生ACLF的独立危险因素。在发生ACLF的患者中，Cox多因素回归分析中只有终末期肝病模型联合血清钠浓度（MELD-Na）评分及拉米夫定（LAM）停药后复发是12周死亡率的独立预测因素。人工肝支持系统（ALSS）对ACLF患者的12周生存率无改善。我们进一步将22.35定义为MELD-Na评分预测ACLF患者12周死亡率的最佳截断值，AUROC为0.817，敏感性为76.5%，特异性为75.9%。
年龄≥30岁和入院时HBVDNA≤1000拷贝与ACLF的发生密切相关，较高的MELD-Na评分及LAM停药后复发与CHB患者停用NAs后发生ACLF的患者12周死亡率密切相关。
