Effect of Nucleos(t)ide Analogues Withdrawal on Survival Outcomes in Patients With Hepatitis B Virus-Related Acute-on-Chronic Liver Failure.

BACKGROUND/AIMS: Nucleos(t)ide analogues (NA) withdrawal is an important cause of hepatitis B virus (HBV) infection relapse or flare, potentially triggering HBV-related acute-on-chronic liver failure (HBV-ACLF). Although both NA withdrawal and spontaneous severe acute exacerbation (SAE) of chronic hepatitis B are recognised HBV-ACLF triggers, comparative evidence regarding their distinct clinical trajectories remains absent. This multicenter retrospective cohort study sought to determine whether NA withdrawal independently predicts adverse outcomes in HBV-related ACLF compared to SAE-induced cases.

METHODS

We retrospectively enrolled consecutive patients with HBV-ACLF admitted to four tertiary hospitals in China. The relationship between NA withdrawal and all-cause mortality in HBV-ACLF patients was evaluated using multivariate Cox regression analysis. Additionally, sensitivity analyses including propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were performed.

RESULTS

Among the 313 HBV-ACLF patients, 66 patients (21.1%) experienced NA withdrawal. HBV-ACLF patients in the NA-withdrawal group exhibited lower liver enzyme levels and higher infection rates at diagnosis compared with those in the NA-naïve group. Multivariate Cox regression models indicated that, after adjusting for demographic and clinical confounders, NA withdrawal was significantly associated with 90-day mortality (hazard ratio [HR], 1.610; 95% confidence interval [CI], 1.095-2.365; p = 0.015) and 180-day mortality (HR, 1.549; 95% CI, 1.057-2.271; p = 0.025). Notably, the association remained consistent following PSM and IPTW.

CONCLUSIONS

NA withdrawal is an independent risk factor for death in patients with HBV-ACLF, underlining the importance of adherence to NA therapy in patients with chronic hepatitis B.