Clinical features and prognosis of HBV-related acute-on-chronic liver failure in pregnancy / 临床肝胆病杂志

ABSTRACT

Objective To investigate the clinical features and prognosis of pregnant women with HBV-related acute-on-chronic liver failure (HBV-ACLF). Methods A retrospective analysis was performed for the clinical data of 26 pregnant women with HBV-ACLF who were admitted to Shanghai Public Health Clinical Center from June 2008 to July 2020, including age, gestational weeks at disease onset, parity, initial symptoms, complications on admission, laboratory markers [white blood cell count, hemoglobin, platelet count, alanine aminotransferase, total bilirubin (TBil), albumin, serum creatinine, Model for End-Stage Liver Disease (MELD) score, HBsAg, and HBV DNA], abdominal ultrasound, mode of delivery, fetus conditions, treatment measures, and prognosis. The t -test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test and the Fisher's exact test were used for comparison of categorical data between two groups. Results Among the 26 patients, 8 died within 28 days after disease onset, and the mortality rate reached 30.8%. There were 22 multiparous patients, accounting for 84.6%, and HBV-ACLF often occurred in the third trimester of pregnancy (20/26, 76.9%), with a mean gestational age of 30.9±5.8 weeks. HBV-ACLF often had atypical clinical manifestations, and initial symptoms included weakness, poor appetite (21/26, 80.8%), and yellow urine (19/26, 73.1%). Compared with the survival group, the death group had significantly higher levels of TBil ( Z =-2.056, P =0.041), prothrombin time ( Z =-2.362, P =0.016), international normalized ratio ( Z =-2.528, P =0.009), and MELD score ( Z =-2.223, P =0.026), a significantly longer time from initial symptom to diagnosis ( Z =-2.468, P =0.021), significantly higher HBV DNA level ( χ 2 =7.571, P =0.021), degree of hepatic encephalopathy ( χ 2 =24.775, P < 0.001), and incidence rate of complications ( χ 2 =5.951, P =0.042), and significantly lower levels of fibrinogen ( Z =-2.667, P =0.006) and prothrombin time activity ( Z =-2.365, P =0.016). Conclusion HBV-ACLF is a serious complication in the third trimester of pregnancy and is often observed in multiparous patients, with an extremely high short-term mortality. It often has atypical clinical manifestations in the early stage, and high MELD score, high viral load, and complications often indicate a poor prognosis.