Department of Infectious Diseases, Huashan Hospital, Fudan University, 12 Middle Urumqi Road, Shanghai, 200040, China.
Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, China.
Dig Dis Sci. 2021 Jan;66(1):284-295. doi: 10.1007/s10620-020-06149-x. Epub 2020 Mar 6.
Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a dynamic but reversible disease.
We aimed to clarify whether the change in Chinese Group on the Study of Severe Hepatitis B-ACLF (COSSH-ACLF) grade in HBV-ACLF patients can be used to predict prognosis, and to explore the appropriate conditions for performing urgent liver transplantation.
We assessed the COSSH-ACLF grades of HBV-ACLF patients at different time points from June 2013 to May 2019 at Huashan Hospital in Shanghai, China, and analyzed the relationship between the change in grade and patient prognosis.
A total of 207 HBV-ACLF patients were enrolled, of which 79 underwent urgent liver transplantation. Their COSSH-ACLF grades were calculated at diagnosis, 3-7 days after diagnosis, and on the final day. Most of the final ACLF grades were consistent with their corresponding grades at days 3-7 after diagnosis (62.5%), while only 44.5% were in accordance with the initial grades at diagnosis. In patients who had a poor prognosis (initial ACLF-3 and ACLF-2 or -3 at days 3-7), the 28-day survival rate was 93.3% in those who underwent transplantation and 6.8% in those who did not (P < 0.0001). However, in patients who had a good prognosis (ACLF-0 or ACLF-1 at days 3-7), the 28-day survival rate was 100% in transplanted patients and 91.5% in non-transplanted patients (P = 0.236).
Reevaluation of the COSSH-ACLF grade 3-7 days after diagnosis could potentially show an indication for urgent liver transplantation.
乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）是一种动态但可逆转的疾病。
本研究旨在阐明乙型肝炎病毒相关慢加急性肝衰竭（HBV-ACLF）患者中国重症乙型肝炎肝衰竭临床注册研究（COSSH-ACLF）分级的变化是否可用于预测预后，并探讨进行紧急肝移植的合适条件。
我们评估了 2013 年 6 月至 2019 年 5 月期间在上海华山医院就诊的 HBV-ACLF 患者在不同时间点的 COSSH-ACLF 分级，并分析了分级变化与患者预后之间的关系。
共纳入 207 例 HBV-ACLF 患者，其中 79 例行紧急肝移植。我们计算了他们在诊断时、诊断后 3-7 天和最后一天的 COSSH-ACLF 分级。大多数最终的 ACLF 分级与诊断后 3-7 天的对应分级一致（62.5%），而只有 44.5%与初始诊断时的分级一致。在预后不良的患者（初始 ACLF-3 和 ACLF-2 或 -3 在 3-7 天）中，行移植治疗的患者 28 天生存率为 93.3%，未行移植治疗的患者为 6.8%（P<0.0001）。然而，在预后良好的患者（3-7 天 ACLF-0 或 ACLF-1）中，行移植治疗的患者 28 天生存率为 100%，未行移植治疗的患者为 91.5%（P=0.236）。
诊断后 3-7 天重新评估 COSSH-ACLF 分级可能提示需要紧急肝移植。
