Department of Infectious Disease, Zhejiang Hospital, Hangzhou, China.
Department of Respiration, The First Hospital of Jiaxing (The Affiliated Hospital of Jiaxing University), Jiaxing, Zhejiang, China.
Dis Markers. 2022 Jun 1;2022:3451544. doi: 10.1155/2022/3451544. eCollection 2022.
Hepatorenal syndrome (HRS) could occur when patients get decompensated liver cirrhosis. Meanwhile, hepatitis B virus (HBV) infection raises the risk of mortality of the end-stage liver diseases. As the artificial liver support system (ALSS) has been applied in liver failure, whether ALSS could benefit HBV-derived HRS remains uncertain. We retrospectively enlisted eligible HRS patients and compared the baseline characteristics and prognosis between HBV-derived HRS and non-HBV-derived HRS. Furthermore, propensity score matching (PSM) and Cox regression analyses were used to assess the beneficial effect of ALSS on HBV-derived HRS. In addition, a stratified analysis was carried out according to the degree of acute kidney injury (AKI) and the number of organ failures to observe in which populations ALSS can obtain the most excellent therapeutic effect. 669 patients were diagnosed as HRS, including 298 HBV negative and 371 HBV positive. Baseline characteristics were different between patients with HBV positive and HBV negative. HBV-derived HRS has higher 28-day mortality, though without a statistical difference. After PSM, 50 patients treated with ALSS and 150 patients treated with standard medical treatment (SMT) constituted a new cohort for the following analysis. We found that ALSS could significantly benefit HRS patients ( = 0.025). Moreover, the median survival time of patients treated with ALSS was longer than those treated with SMT. INR, neutrophil percentage, and treatment with ALSS were independent predictive factors for short-term mortality in HBV-derived HRS. The stratified analysis showed that ALSS could reduce the 28-day mortality of patients with HBV-derived HRS, especially those in AKI stage 3 and with organ failure ≥ 2. Additionally, serum bilirubin was significantly lower after ALSS, and the alteration of INR and creatinine were independent predictive elements for the mortality of HBV-derived HRS. HBV-derived HRS is more severe than non-HBV-derived HRS and has a worse prognosis. ALSS could reduce the short-term mortality of patients with HBV-derived HRS, especially those in AKI stage 3 and with organ failure ≥ 2. INR and the change of creatinine and INR could predict the prognosis of HBV-derived HRS. ChiCTR2200060123.
肝肾综合征（HRS）可发生于失代偿期肝硬化患者，而乙型肝炎病毒（HBV）感染增加了终末期肝病患者的死亡率。由于人工肝支持系统（ALSS）已应用于肝衰竭，ALSS 是否有益于 HBV 相关性 HRS 尚不确定。我们回顾性纳入了符合条件的 HRS 患者，并比较了 HBV 相关性 HRS 和非 HBV 相关性 HRS 的基线特征和预后。此外，还采用倾向评分匹配（PSM）和 Cox 回归分析评估了 ALSS 对 HBV 相关性 HRS 的有益作用。另外，还根据急性肾损伤（AKI）程度和器官衰竭数量进行了分层分析，以观察 ALSS 可在哪些人群中获得最佳的治疗效果。共诊断出 669 例 HRS 患者，其中 HBV 阴性 298 例，HBV 阳性 371 例。HBV 阳性和 HBV 阴性患者的基线特征不同。HBV 相关性 HRS 的 28 天死亡率较高，但无统计学差异。PSM 后，50 例接受 ALSS 治疗和 150 例接受标准药物治疗（SMT）的患者构成了新的队列进行后续分析。结果发现，ALSS 可显著改善 HRS 患者的预后（ = 0.025）。此外，接受 ALSS 治疗的患者中位生存时间长于接受 SMT 治疗的患者。INR、中性粒细胞百分比和 ALSS 治疗是 HBV 相关性 HRS 短期死亡率的独立预测因素。分层分析显示，ALSS 可降低 HBV 相关性 HRS 患者的 28 天死亡率，特别是 AKI 3 期和器官衰竭≥2 者。此外，ALSS 后血清胆红素显著降低，INR 和肌酐的变化是 HBV 相关性 HRS 死亡率的独立预测因素。HBV 相关性 HRS 比非 HBV 相关性 HRS 更严重，预后更差。ALSS 可降低 HBV 相关性 HRS 患者的短期死亡率，特别是 AKI 3 期和器官衰竭≥2 者。INR 和肌酐及 INR 的变化可预测 HBV 相关性 HRS 的预后。ChiCTR2200060123。
