Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
J Gastroenterol Hepatol. 2021 Jan;36(1):208-216. doi: 10.1111/jgh.15113. Epub 2020 Jul 1.
Tri-typing of acute-on-chronic liver failure (ACLF), as proposed by the World Gastroenterology Organization (WGO), has not been validated in patients infected with hepatitis B virus (HBV). We aim to compare the three types of ACLF patients in clinic characteristics.
Hospitalized ACLF patients with chronic hepatitis B from five hepatology centers were retrospectively selected and grouped according to the WGO classification. For each group, we investigated laboratory tests, precipitating events, organ failure, and clinical outcome.
Compared with type-B (n = 262, compensated cirrhosis) and type-C (n = 129, decompensated cirrhosis) ACLF, type-A patients (n = 195, non-cirrhosis) were associated with a younger age, the highest platelet counts, the highest aminotransferase levels, and the most active HBV replications. HBV reactivation were more predominant in type-A, while bacterial infections in type-B and type-C ACLF cases. Liver failure (97.4%) and coagulation failure (86.7%) were most common in type-A compared with type-B or type-C ACLF patients. Kidney failure was predominantly identified in type-C subjects (41.9%) and was highest (23/38, 60.5%) in grade 1 ACLF patients. Furthermore, type-C ACLF showed the highest 28-day (65.2%) and 90-day (75.3%) mortalities, compared with type-A (48.7% and 54.4%, respectively) and type-B (48.4% and 62.8%, respectively) ACLF cases. Compared with type-A (11.7%) ACLF patients, the increased mortality from 28 to 90 days was higher in type-B (31.6%) and type-C (37.5%).
Tri-typing of HBV-related ACLF in accordance with the WGO definition was able to distinguish clinical characteristics, including precipitating events, organ failure, and short-term prognosis in ACLF patients.
世界胃肠病组织（WGO）提出的急性慢性肝衰竭（ACLF）三分型在乙型肝炎病毒（HBV）感染患者中尚未得到验证。我们旨在比较三种类型的 ACLF 患者的临床特征。
从五个肝病中心回顾性选择住院的乙型肝炎相关 ACLF 患者，并根据 WGO 分类进行分组。对于每个组，我们调查了实验室检查、诱发事件、器官衰竭和临床结局。
与 B 型（n=262，代偿性肝硬化）和 C 型（n=129，失代偿性肝硬化）ACLF 患者相比，A 型（n=195，非肝硬化）患者年龄较小，血小板计数较高，转氨酶水平较高，HBV 复制较活跃。HBV 再激活在 A 型更为常见，而细菌感染在 B 型和 C 型 ACLF 病例中更为常见。与 B 型或 C 型 ACLF 患者相比，A 型患者的肝功能衰竭（97.4%）和凝血功能衰竭（86.7%）更为常见。肾衰竭主要发生在 C 型患者中（41.9%），在 1 级 ACLF 患者中（23/38，60.5%）最高。此外，C 型 ACLF 的 28 天（65.2%）和 90 天（75.3%）死亡率最高，与 A 型（分别为 48.7%和 54.4%）和 B 型（分别为 48.4%和 62.8%）ACLF 患者相比。与 A 型（11.7%）ACLF 患者相比，B 型（31.6%）和 C 型（37.5%）从 28 天到 90 天的死亡率增加更高。
根据 WGO 定义对 HBV 相关 ACLF 进行三分型能够区分临床特征，包括 ACLF 患者的诱发事件、器官衰竭和短期预后。
