Dynamic changes of clinical features that predict the prognosis of acute-on-chronic hepatitis B liver failure: a retrospective cohort study

Abstract

Objective: The natural history of acute-on-chronic hepatitis B liver failure (ACHBLF) is complex and highly variable. However, the global clinical characteristics of this entity remain ill-defined. We aimed to investigate the dynamic patterns of the natural progression as well as their impact on the outcomes of ACHBLF.

Methods: The clinical features and disease states were retrospectively investigated in 54 patients with ACHBLF at the China South Hepatology Center. The clinical and laboratory profiles including hepatic encephalopathy (HE), hepatorenal syndrome (HRS), and spontaneous bacterial peritonitis (SBP) were evaluated. The disease state estimated by the model for end-stage liver disease (MELD) score and the dynamic patterns during the clinical course of ACHBLF were extrapolated.

Results: Twenty-two patients died during the 3-month follow-up period (40.74%). The patients were predominantly male (88.89%). Baseline characteristics showed that there were significant differences in only hepatitis B virus (HBV) DNA levels and platelet count between the deceased and surviving patients (P=0.014 and P=0.012, respectively). Other baseline characteristics were similar in both groups. The dynamic state of the MELD score gradually increased from an initial hepatic flare until week 4 of ACHBLF progression. There were notable changes of the dynamic state of the MELD score at two time points (week 2 and week 4) during ACHBLF progression. The MELD scores were significantly greater in the death group (24.80 ± 2.99) than in the survival group (19.49±1.96, P<0.05) during the clinical course of ACHBLF; the MELD scores of the survival group began to decrease from week 4, while they continued to rise and eventually decreased as more patients died. The gradients of the ascent and descent stages could predict exactly the severity and prognosis of ACHBLF.

Conclusions: The natural progression of ACHBLF could be divided approximately into four stages including ascent, plateau, descent, and convalescence stages according to different trends of liver failure progression, respectively. Thus, the special patterns of the natural progression of ACHBLF may be regarded as a significant predictor of the 3-month mortality of ACHBLF.

Keywords: Acute-on-chronic hepatitis B liver failure; Clinical features; Dynamic patterns; Prognosis; and MELD score..

Fig 1

A flow diagram of study participants.

Fig 2

(A) Dynamic state of the hepatic encephalopathy rate in the death and survival groups during the course of ACHBLF progression. (B) Dynamic state of the hepatorenal syndrome rate in the death and survival groups during the course of ACHBLF progression. (C) Dynamic state of the spontaneous bacterial peritonitis rate in the death and survival groups during the course of ACHBLF progression. (D) Thickness of the right lobe of the liver by ultrasound scanning in the death and survival groups during the course of ACHBLF progression. The numbers at the top of the chart indicate the p values for differences between the respective groups. NS, no statistical significance. Data are described as percentages. ACHBLF, acute-on-chronic hepatitis B liver failure.

Fig 3

(A) Dynamic state of MELD scores of patients with ACHBLF during disease progression. Data are the mean ± standard deviation,*P < 0.01 compared with the MELD score at week 1, ^∆P < 0.05 compared with the MELD score of survival patients at week 2. ^§P > 0.05 compared with the MELD score at week 4, #P < 0.05 compared with the MELD score at week 4. (B) Dynamic patterns of the natural progression of ACHBLF. The natural progression of ACHBLF may be divided approximately into four stages including ascent, plateau, descent, and convalescence stages, respectively. The gradients of ascent and descent stages can influence exactly the severity and prognosis of ACHBLF.