Static and dynamic prognostic factors for hepatitis-Brelated acute-on-chronic liver failure

• Published in: Clinical and molecular hepatology Vol. 21; no. 3; pp. 232 - 241
• Main Authors: Jung Min Ha, Won Sohn, Ju Yeon Cho, Jeung Hui Pyo, Kyu Choi, Dong Hyun Sinn, Geum-youn Gwak, Moon Seok Choi, Joon Hyeok Lee, Kwang Chul Koh, Seung Woon Paik, Byung Chul Yoo, Yong-han Paik
• Format: Journal Article
• Language: Korean
• Published: 대한간학회 30.09.2015
• Subjects: Acute-on-chronic liver failure; Chronic hepatitis B; Liver transplantation; Model for End-Stage Liver Disease
• ISSN: 2287-2728; 2287-285X

Background/Aims: Hepatitis-B-related acute-on-chronic liver failure has a poor prognosis. However, the advent of potent oral antiviral agents means that some patients can now recover with medical treatment. We aimed to identify the prognostic factors for hepatitis-B-related acute-on-chronic liver failure including the initial as well as the dynamically changing clinical parameters during admission. Methods: Sixty-seven patients were retrospectively enrolled from 2003 to 2012 at Samsung Medical Center. The patients were classified into three categories: Recovery group (n=23), Liver transplantation group (n=28), and Death group (n=16). The Liver transplantation and Death groups were combined into an Unfavorable prognosis group. We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals. Results: A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (≥28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (≥grade III) (OR=15.41, P=0.013). Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group ( P=0.016). Conclusions: Dynamic changes in clinical parameters during admission are useful prognostic factors for hepatitis-Brelated acute-on-chronic liver failure. (Clin Mol Hepatol 2015;21:232-241)