Predictors of the outcomes of acute-on-chronic hepatitis B liver failure

被引:45
作者
Fan, Hsiu-Lung [1 ]
Yang, Po-Sheng [2 ]
Chen, Hui-Wei [3 ]
Chen, Teng-Wei [1 ]
Chan, De-Chuan [1 ]
Chu, Chi-Hong [1 ]
Yu, Jyh-Cherng [1 ]
Kuo, Shih-Ming [4 ]
Hsieh, Chung-Bao [1 ]
机构
[1] Triserv Gen Hosp, Natl Def Med Ctr, Dept Surg, Div Gen Surg, Taipei 11490, Taiwan
[2] Mackay Mem Hosp, Dept Surg, Div Gen Surg, Taipei 11490, Taiwan
[3] Univ Pittsburgh, Sch Med, Pittsburgh, PA 15261 USA
[4] Triserv Gen Hosp, Natl Def Med Ctr, Dept Surg, Div Pediat Surg, Taipei 11490, Taiwan
关键词
Lamivudine; Liver failure; Hepatitis B virus; Acute Physiology and Chronic Health Evaluation II score; Model for end-stage liver disease scores; DISEASE SCORING SYSTEM; INTENSIVE-CARE-UNIT; LAMIVUDINE TREATMENT; HOSPITAL MORTALITY; PLASMA-EXCHANGE; APACHE-II; PROGNOSIS; MODEL; TRANSPLANTATION;
D O I
10.3748/wjg.v18.i36.5078
中图分类号
R57 [消化系及腹部疾病];
学科分类号
100201 [内科学];
摘要
AIM: To identify the risk factors in predicting the outcome of acute-on-chronic hepatitis B liver failure patients. METHODS: We retrospectively divided 113 patients with acute-on-chronic liver failure-hepatitis B virus (ACLF-HBV) and without concurrent hepatitis C or D virus infection and hepatocellular carcinoma into two groups according to their outcomes after anti-HBV therapy. Their demographic, clinical, and biochemical data on the day of diagnosis and after the first week of treatment were analyzed using the Mann-Whitney U test, Fisher's exact test, and a multiple logistic regression analysis. RESULTS: The study included 113 patients (87 men and 26 women) with a mean age of 49.84 years. Fifty-two patients survived, and 61 patients died. Liver failure (85.2%), sepsis (34.4%), and multiple organ failure (39.3%) were the main causes of death. Multivariate analyses showed that Acute Physiology and Chronic Health Evaluation (APACHE) II scores >= 12 [odds ratio (OR) = 7.160, 95% CI: 2.834-18.092, P < 0.001] and positive blood culture (OR = 13.520, 95% CI: 2.740-66.721, P = 0.001) on the day of diagnosis and model for end-stage liver disease (MELD) scores >= 28 (OR = 8.182, 95% CI: 1.884-35.527, P = 0.005) after the first week of treatment were independent predictors of mortality. CONCLUSION: APACHE II scores on the day of diagnosis and MELD scores after the first week of anti-HBV therapy are feasible predictors of outcome in ACLF-HBV patients. (c) 2012 Baishideng. All rights reserved.
引用
收藏
页码:5078 / 5083
页数:6
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