Original Article
Clinical application of acute-on-chronic liver failure classification recommended by World Gastroenterology Organization
Mu Xiuying, Tong Jingjing, Xu Xiang, Chen Jing, Su Haibin, Liu Xiaoyan, Guan Chongdan, Pang Fei, Zhai Xingran, Hu Jinhua
Published 2018-12-25
Cite as Inter J Epidemionl Infect Dis, 2018,45(6): 390-394. DOI: 10.3760/cma.j.issn.1673-4149.2018.06.004
Abstract
ObjectiveTo explore whether the definition of acute-on-chronic liver failure (ACLF) which is recommended by World Gastroenterology Organization (WGO) is suitable for the clinical management of HBV-ACLF patients in China.
MethodsThe clinical data of 606 HBV-ACLF patients hospitalized in the Fifth Medical Center of PLA General Hospital were retrospectively collected and divided into three groups of type A (183 cases) , type B (317 cases) and type C (106 cases) according to the ACLF classification criteria proposed by WGO. The clinical features and prognosis of three types of patients were compared. The influencing factors of prognosis were analyzed by Cox’s proportional hazards regression model.
ResultsLaboratory parameters such as WBC, PLT count, albumin (ALB) , TBil, ALT and total cholesterol (TC) levels were different among the three groups (H=11.22, 159.00, 59.13, 21.68, 92.15 and 33.24, P all<0.05) . The incidence rate of bacterial infections, acute kidney injury (AKI) and gastrointestinal bleeding within 28 days were also significantly different among the three groups (χ2=20.03, 16.07 and 14.46, P all<0.05) . The 28-day mortality rates in type A, B and C group were 22.2%, 27.1% and 37.6%, respectively, with a significant difference (χ2=7.96, P <0.05) . For type A ACLF patients, international normalized ratio (INR) , bacterial infections, hepatic encephalopathy (HE) and AKI were independent risk factors of 28-day mortality. In addition, age, WBC, TBil, bacterial infections, HE and AKI were the risk factors of type B. HE and AKI were the risk factors of type C.
ConclusionsThe classification recommended by WGO is suitable for HBV-ACLF patients in China. The clinical characteristics and prognosis of three types are different, which is beneficial to the administration and management of clinical patients.
Key words:
Hepatitis B virus; Acute-on-chronic liver failure; World Gastroenterology Organization; Classification; Prognosis analysis
Contributor Information
Mu Xiuying
Peking University 302 Clinical Medical School, Beijing 100039, China
Tong Jingjing
Liver Failure Treatment and Research Center, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Xu Xiang
Liver Failure Treatment and Research Center, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Chen Jing
Liver Failure Treatment and Research Center, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Su Haibin
Liver Failure Treatment and Research Center, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Liu Xiaoyan
Liver Failure Treatment and Research Center, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Guan Chongdan
Liver Failure Treatment and Research Center, the Fifth Medical Center of PLA General Hospital, Beijing 100039, China
Pang Fei
Department of Gastroenterology, Qilu Hospital of Shandong University (Qingdao) , Qingdao 266035, Shandong, China
Zhai Xingran
Peking University 302 Clinical Medical School, Beijing 100039, China
Hu Jinhua
Peking University 302 Clinical Medical School, Beijing 100039, China