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Title: [Discussion and evaluation of diagnostic criteria for hepatitis B virus-related acute-on-chronic pre-liver failure].
Author: Li C, Zhu B, Lyu S, You SL.
Journal: Zhonghua Gan Zang Bing Za Zhi; 2018 Feb 20; 26(2):130-135. PubMed ID: 29804380.
Abstract:
Objective: To investigate the concept of hepatitis B virus (HBV)-related acute-on-chronic pre-liver failure (pre-ACLF), and to develop and evaluate the diagnostic criteria for this disease. Methods: A retrospective analysis was performed for the clinical data of 754 patients with severe acute exacerbation (SAE) of HBV-related chronic liver disease, and their clinical features were identified. A multivariate logistic regression analysis was used to determine the risk factors for acute-on-chronic liver failure (ACLF). The inclusion rate of patients with SAE-HBV-related chronic liver disease and the detection rate of ACLF patients were analyzed to evaluate the value of four different versions of diagnostic criteria for pre-liver failure. The t-test, an analysis of variance, the Mann-Whitney U test, and the chi-square test were used for statistical analysis based on data type. Results: The incidence rate of ACLF in the patients with SAE-HBV-related chronic liver disease was 9.9% and the time to progression to ACLF was 12.0 ± 6.7 days. The multivariate logistic regression analysis showed that HBV reactivation (odds ratio [OR] = 5.118), direct bilirubin ratio (D/T) (OR = 1.041), age (OR = 1.033), total bilirubin (TBil) (OR = 1.005), prothrombin activity (PTA) (OR = 0.880), and serum sodium (Na) (OR = 0.918) were independent risk factors for ACLF. Group B (51.3 μmol/L < TBil < 171.1 μmol/L and 40%≤PTA < 60%, 4.2%) had a significantly lower incidence rate of ACLF than group A (51.3 μmol/L < TBil < 171.1 μmol/L and PTA < 40%, 13.7%) and group C (TBil > 171.1 μmol/L and 40% < PTA < 60%, 20.3%) (P < 0.001). Group C had a significantly shorter time to progression to ACLF than group A (10.5 ± 6.1 days vs 15.6 ± 7.4 days, P = 0.008). A total of 45 patients met the diagnostic criteria developed by Chongqing and the incidence rate of ACLF was 2.2%; 154 patients met the diagnostic criteria developed by Zhejiang and the incidence rate of ACLF was 7.1%; 188 patients met the diagnostic criteria in the Chinese guidelines and the incidence rate of ACLF was 6.4%; 117 patients met the diagnostic criteria for SAE-CHB and the incidence rate of ACLF was 9.4%. Conclusion: At present, these four versions of diagnostic criteria for pre-liver failure are not fully applicable to the clinical practice in China. The diagnostic criteria for HBV-related pre-ACLF should include important assessment indices which affect its progression to ACLF. 目的： 对乙型肝炎病毒（HBV）相关慢加急性肝衰竭（ACLF）前期患者的概念及诊断标准进行探讨及评价。 方法： 选取2014年9月至2016年9月间收治的754例HBV相关慢性肝病严重急性恶化（SAE）的患者进行回顾性研究，明确患者的临床特征。运用多因素logistic回归分析，得出患者发生ACLF的危险因素。通过对SAE-HBV相关慢性肝病患者纳入率和对ACLF患者检出率的研究，评价现有四种肝衰竭前期诊断标准的应用价值。据资料不同分别采用t检验、方差分析、Mann-Whitney U检验、χ(2)检验进行统计学分析。 结果： SAE-HBV相关慢性肝病患者的ACLF发生率为9.9%，进展至ACLF的时间为（12.0±6.7）d。多因素logistic回归分析显示，HBV再激活（OR = 5.118）、直接胆红素比例（D/T）（OR = 1.041）、年龄（OR = 1.033）、总胆红素（TBil）（OR = 1.005）、凝血酶原活动度（PTA）（OR = 0.880）、血清钠（Na）（OR = 0.918）是影响患者发生ACLF的独立危险因素。51.3 μmol/L<TBil<171.1 μmol/L且40%≤PTA<60%组（B组，4.2%）患者ACLF发生率低于51.3 μmol/L<TBil<171.1 μmol/L且PTA<40%组（A组，13.7%）（P<0.001）、TBil>171.1 μmol/L且40%<PTA<60%组（C组，20.3%）（P<0.001）。C组[（10.5±6.1）d]进展至ACLF时间低于A组[（15.6±7.4）d]（P = 0.008）。45例患者符合重庆诊断标准，ACLF发生率为2.2%。154例患者符合浙江诊断标准，ACLF发生率为7.1%。188例患者符合2012年我国指南诊断标准，ACLF发生率为6.4%。117例患者符合SAE-CHB诊断标准，ACLF发生率为9.4%。 结论： 目前四种肝衰竭前期诊断标准不完全适用于我国临床实际。HBV相关前期ACLF诊断标准应该纳入更多影响其进展至ACLF的重要评价指标。.

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