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. 2016 May 5:6:25487.
doi: 10.1038/srep25487.

Characteristics, Diagnosis and Prognosis of Acute-on-Chronic Liver Failure in Cirrhosis Associated to Hepatitis B

Hai Li  1   2   3 , Liu-Ying Chen  1   2   3 , Nan-Nan Zhang  1   2   3 , Shu-Ting Li  1   2   3 , Bo Zeng  1   2   3 , Marco Pavesi  4 , Àlex Amorós  4 , Rajeshwar P Mookerjee  5 , Qian Xia  6 , Feng Xue  6 , Xiong Ma  1   2   3 , Jing Hua  1   2   3 , Li Sheng  1   2   3 , De-Kai Qiu  1   2   3 , Qing Xie  7 , Graham R Foster  8 , Geoffrey Dusheiko  5 , Richard Moreau  9 , Pere Gines  10 , Vicente Arroyo  10   11 , Rajiv Jalan  5
Affiliations

Characteristics, Diagnosis and Prognosis of Acute-on-Chronic Liver Failure in Cirrhosis Associated to Hepatitis B

Hai Li et al. Sci Rep. .

Abstract

The diagnostic and prognostic criteria of acute-on-chronic liver failure (ACLF) were developed in patients with no Hepatitis B virus (HBV) cirrhosis (CANONIC study). The aims of this study were to evaluate whether the diagnostic (CLIF-C organ failure score; CLIF-C OFs) criteria can be used to classify patients; and the prognostic score (CLIF-C ACLF score) could be used to provide prognostic information in HBV cirrhotic patients with ACLF. 890 HBV associated cirrhotic patients with acute decompensation (AD) were enrolled. Using the CLIF-C OFs, 33.7% (300 patients) were diagnosed as ACLF. ACLF was more common in the younger patients and in those with no previous history of decompensation. The most common organ failures were 'hepatic' and 'coagulation'. As in the CANONIC study, 90-day mortality was extremely low in the non-ACLF patients compared with ACLF patients (4.6% vs 50%, p < 0.0001). ACLF grade and white cell count, were independent predictors of mortality. CLIF-C ACLFs accurately predicted short-term mortality, significantly better than the MELDs and a disease specific score generated for the HBV patients. Current study indicates that ACLF is a clinically and pathophysiology distinct even in HBV patients. Consequently, diagnostic criteria, prognostic scores and probably the management of ACLF should base on similar principles.

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Conflict of interest statement

There are potential competing financial interests as follows. Rajiv Jalan received research funding from Vital Therapies, has served on Scientific Advisory Board for Conatus Pharma, and received lecture fees from Gambro and has on-going research collaboration with Gambro, Grifols and is the Principal Investigator of an Industry sponsored study (Sequana Medical). He is also inventor for a drug, L-ornithine phenyl acetate which UCL has licensed to Ocera Therapeutics. Vicente Arroyo has research grants from Grifols.

Figures

Figure 1
Figure 1. Screening, enrollment, and flow of patients according to the presence or absence of ACLF according to CLIF-C OF score.
Figure 2
Figure 2
(A) Relationship between the severity of ACLF and the WCC.(B) Mortality rate at 28 days and 90 days according to the grade of ACLF.
Figure 3
Figure 3. Relationship between the expected probability of death at 28-days, the presence or the absence of ACLF and the white cell count.
Figure 4
Figure 4
Panel (A): Accuracy of the CLIF-C ACLFs (red line) as compared to MELDs (green) and MELD-Nas (orange) in predicting 28-day and 90-day mortality of patients with ACLF associated to cirrhosis due to HBV infection. Comparison of the areas under the ROC curves (AUROCs) estimated for each score. The CLIF-C ACLFs showed a significantly higher predictive ability in comparison with the MELDs and MELD-Nas scores for both the 28-day and 90-day mortality. Panel (B): Accuracy of the CLIF-C ADs (red line) as compared to MELDs (green) and MELD-Nas (orange) in predicting 6-month and 1-year mortality of patients with AD (without ACLD) due to HBV associated cirrhosis. Comparison of the AUROCs estimated for each score. The CLIF-C ADs showed significantly higher predictive ability in comparison to the MELDs.
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References

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