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Role of precipitants in transition of acute decompensation to acute-on-chronic liver failure in patients with HBV-related cirrhosis
BACKGROUND & AIMS: Pre-acute-on-chronic liver failure (ACLF) is a distinct intermediate stage between acute decompensation (AD) and ACLF. However, identifying patients with pre-ACLF and predicting progression from AD to ACLF is difficult. This study aimed to identify pre-ACLF within 28 days, and...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9424579/ https://www.ncbi.nlm.nih.gov/pubmed/36052222 http://dx.doi.org/10.1016/j.jhepr.2022.100529 |
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author | Wang, Tongyu Tan, Wenting Wang, Xianbo Zheng, Xin Huang, Yan Li, Beiling Meng, Zhongji Gao, Yanhang Qian, Zhiping Liu, Feng Lu, Xiaobo Yan, Huadong Zheng, Yubao Zhang, Weituo Yin, Shan Gu, Wenyi Zhang, Yan Dong, Fuchen Wei, Jianyi Deng, Guohong Xiang, Xiaomei Zhou, Yi Hou, Yixin Zhang, Qun Xiong, Shue Liu, Jing Long, Liyuan Chen, Ruochan Chen, Jinjun Jiang, Xiuhua Luo, Sen Chen, Yuanyuan Jiang, Chang Zhao, Jinming Ji, Liujuan Mei, Xue Li, Jing Li, Tao Zheng, Rongjiong Zhou, Xinyi Ren, Haotang Shi, Yu Li, Hai |
author_facet | Wang, Tongyu Tan, Wenting Wang, Xianbo Zheng, Xin Huang, Yan Li, Beiling Meng, Zhongji Gao, Yanhang Qian, Zhiping Liu, Feng Lu, Xiaobo Yan, Huadong Zheng, Yubao Zhang, Weituo Yin, Shan Gu, Wenyi Zhang, Yan Dong, Fuchen Wei, Jianyi Deng, Guohong Xiang, Xiaomei Zhou, Yi Hou, Yixin Zhang, Qun Xiong, Shue Liu, Jing Long, Liyuan Chen, Ruochan Chen, Jinjun Jiang, Xiuhua Luo, Sen Chen, Yuanyuan Jiang, Chang Zhao, Jinming Ji, Liujuan Mei, Xue Li, Jing Li, Tao Zheng, Rongjiong Zhou, Xinyi Ren, Haotang Shi, Yu Li, Hai |
author_sort | Wang, Tongyu |
collection | PubMed |
description | BACKGROUND & AIMS: Pre-acute-on-chronic liver failure (ACLF) is a distinct intermediate stage between acute decompensation (AD) and ACLF. However, identifying patients with pre-ACLF and predicting progression from AD to ACLF is difficult. This study aimed to identify pre-ACLF within 28 days, and to develop and validate a prediction model for ACLF in patients with HBV-related decompensated cirrhosis. METHODS: In total, 1,736 patients with HBV-related cirrhosis and AD were enrolled from 2 large-scale, multicenter, prospective cohorts. ACLF occurrence within 28 days, readmission, and 3-month and 1-year outcomes were collected. RESULTS: Among 970 patients with AD without ACLF in the derivation cohort, the 94 (9.6%) patients with pre-ACLF had the highest 3-month and 1-year LT-free mortality (61.6% and 70.9%, respectively), which was comparable to those with ACLF at enrollment (57.1% and 67.1%); the 251 (25.9%) patients with unstable decompensated cirrhosis had mortality rates of 22.4% and 32.1%, respectively; while the 507 (57.9%) patients with stable decompensated cirrhosis had the best outcomes (1-year mortality rate of 2.6%). Through Cox proportional hazard regression, specific precipitants, including hepatitis B flare with HBV reactivation, spontaneous hepatitis B flare with high viral load, superimposed infection on HBV, and bacterial infection, were identified to be significantly associated with ACLF occurrence in the derivation cohort. A model that incorporated precipitants, indicators of systemic inflammation and organ injuries reached a high C-index of 0.90 and 0.86 in derivation and validation cohorts, respectively. The optimal cut-off value (0.22) differentiated high-risk and low-risk patients, with a negative predictive value of 0.95. CONCLUSIONS: Three distinct clinical courses of patients with AD are validated in the HBV-etiology population. The precipitants significantly impact on AD-ACLF transition. A model developed by the precipitant–systemic inflammation–organ injury framework could be a useful tool for predicting ACLF occurrence. CLINICAL TRIAL NUMBER: NCT02457637 and NCT03641872. LAY SUMMARY: It was previously shown that patients with decompensated cirrhosis could be stratified into 3 groups based on their short-term clinical prognoses. Herein, we showed that this stratification applies to patients who develop cirrhosis as a result of hepatitis B virus infection. We also developed a precipitant-based model (i.e. a model that incorporated information about the exact cause of decompensation) that could predict the likelihood of these patients developing a very severe liver disease called acute-on-chronic liver failure (or ACLF). |
format | Online Article Text |
id | pubmed-9424579 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-94245792022-08-31 Role of precipitants in transition of acute decompensation to acute-on-chronic liver failure in patients with HBV-related cirrhosis Wang, Tongyu Tan, Wenting Wang, Xianbo Zheng, Xin Huang, Yan Li, Beiling Meng, Zhongji Gao, Yanhang Qian, Zhiping Liu, Feng Lu, Xiaobo Yan, Huadong Zheng, Yubao Zhang, Weituo Yin, Shan Gu, Wenyi Zhang, Yan Dong, Fuchen Wei, Jianyi Deng, Guohong Xiang, Xiaomei Zhou, Yi Hou, Yixin Zhang, Qun Xiong, Shue Liu, Jing Long, Liyuan Chen, Ruochan Chen, Jinjun Jiang, Xiuhua Luo, Sen Chen, Yuanyuan Jiang, Chang Zhao, Jinming Ji, Liujuan Mei, Xue Li, Jing Li, Tao Zheng, Rongjiong Zhou, Xinyi Ren, Haotang Shi, Yu Li, Hai JHEP Rep Research Article BACKGROUND & AIMS: Pre-acute-on-chronic liver failure (ACLF) is a distinct intermediate stage between acute decompensation (AD) and ACLF. However, identifying patients with pre-ACLF and predicting progression from AD to ACLF is difficult. This study aimed to identify pre-ACLF within 28 days, and to develop and validate a prediction model for ACLF in patients with HBV-related decompensated cirrhosis. METHODS: In total, 1,736 patients with HBV-related cirrhosis and AD were enrolled from 2 large-scale, multicenter, prospective cohorts. ACLF occurrence within 28 days, readmission, and 3-month and 1-year outcomes were collected. RESULTS: Among 970 patients with AD without ACLF in the derivation cohort, the 94 (9.6%) patients with pre-ACLF had the highest 3-month and 1-year LT-free mortality (61.6% and 70.9%, respectively), which was comparable to those with ACLF at enrollment (57.1% and 67.1%); the 251 (25.9%) patients with unstable decompensated cirrhosis had mortality rates of 22.4% and 32.1%, respectively; while the 507 (57.9%) patients with stable decompensated cirrhosis had the best outcomes (1-year mortality rate of 2.6%). Through Cox proportional hazard regression, specific precipitants, including hepatitis B flare with HBV reactivation, spontaneous hepatitis B flare with high viral load, superimposed infection on HBV, and bacterial infection, were identified to be significantly associated with ACLF occurrence in the derivation cohort. A model that incorporated precipitants, indicators of systemic inflammation and organ injuries reached a high C-index of 0.90 and 0.86 in derivation and validation cohorts, respectively. The optimal cut-off value (0.22) differentiated high-risk and low-risk patients, with a negative predictive value of 0.95. CONCLUSIONS: Three distinct clinical courses of patients with AD are validated in the HBV-etiology population. The precipitants significantly impact on AD-ACLF transition. A model developed by the precipitant–systemic inflammation–organ injury framework could be a useful tool for predicting ACLF occurrence. CLINICAL TRIAL NUMBER: NCT02457637 and NCT03641872. LAY SUMMARY: It was previously shown that patients with decompensated cirrhosis could be stratified into 3 groups based on their short-term clinical prognoses. Herein, we showed that this stratification applies to patients who develop cirrhosis as a result of hepatitis B virus infection. We also developed a precipitant-based model (i.e. a model that incorporated information about the exact cause of decompensation) that could predict the likelihood of these patients developing a very severe liver disease called acute-on-chronic liver failure (or ACLF). Elsevier 2022-07-05 /pmc/articles/PMC9424579/ /pubmed/36052222 http://dx.doi.org/10.1016/j.jhepr.2022.100529 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Research Article Wang, Tongyu Tan, Wenting Wang, Xianbo Zheng, Xin Huang, Yan Li, Beiling Meng, Zhongji Gao, Yanhang Qian, Zhiping Liu, Feng Lu, Xiaobo Yan, Huadong Zheng, Yubao Zhang, Weituo Yin, Shan Gu, Wenyi Zhang, Yan Dong, Fuchen Wei, Jianyi Deng, Guohong Xiang, Xiaomei Zhou, Yi Hou, Yixin Zhang, Qun Xiong, Shue Liu, Jing Long, Liyuan Chen, Ruochan Chen, Jinjun Jiang, Xiuhua Luo, Sen Chen, Yuanyuan Jiang, Chang Zhao, Jinming Ji, Liujuan Mei, Xue Li, Jing Li, Tao Zheng, Rongjiong Zhou, Xinyi Ren, Haotang Shi, Yu Li, Hai Role of precipitants in transition of acute decompensation to acute-on-chronic liver failure in patients with HBV-related cirrhosis |
title | Role of precipitants in transition of acute decompensation to acute-on-chronic liver failure in patients with HBV-related cirrhosis |
title_full | Role of precipitants in transition of acute decompensation to acute-on-chronic liver failure in patients with HBV-related cirrhosis |
title_fullStr | Role of precipitants in transition of acute decompensation to acute-on-chronic liver failure in patients with HBV-related cirrhosis |
title_full_unstemmed | Role of precipitants in transition of acute decompensation to acute-on-chronic liver failure in patients with HBV-related cirrhosis |
title_short | Role of precipitants in transition of acute decompensation to acute-on-chronic liver failure in patients with HBV-related cirrhosis |
title_sort | role of precipitants in transition of acute decompensation to acute-on-chronic liver failure in patients with hbv-related cirrhosis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9424579/ https://www.ncbi.nlm.nih.gov/pubmed/36052222 http://dx.doi.org/10.1016/j.jhepr.2022.100529 |
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