Progress in hepatitis B virus-related acute-on-chronic liver failure treatment in China: A large, multicenter, retrospective cohort study using a propensity score matching analysis.
Hepatobiliary Pancreat Dis Int
; 20(6): 535-541, 2021 Dec.
Article
in En
| MEDLINE
| ID: mdl-34303609
ABSTRACT
BACKGROUND:
Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) has a high short-term mortality. However, the treatment progression for HBV-ACLF in China in the past decade has not been well characterized. The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.METHODS:
This study retrospectively compared short-term (28/56 days) survival rates of two different nationwide cohorts (cohort I 2008-2011 and cohort II 2012-2015). Eligible HBV-ACLF patients were enrolled retrospectively. Patients in the cohorts I and II were assigned either to the standard medical therapy (SMT) group (cohort I-SMT, cohort II-SMT) or artificial liver support system (ALSS) group (cohort I-ALSS, cohort II-ALSS). Propensity score matching analysis was conducted to eliminate baseline differences, and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.RESULTS:
Short-term (28/56 days) survival rates were significantly higher in the ALSS group than those in the SMT group (P < 0.05) and were higher in the cohort II than those in the cohort I (P < 0.001). After propensity score matching, short-term (28/56 days) survival rates were higher in the cohort II than those in the cohort I for both SMT (60.7% vs. 53.0%, 50.0% vs. 39.8%, P < 0.05) and ALSS (66.1% vs. 56.5%, 53.0% vs. 44.4%, P < 0.05) treatments. The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments (P = 0.046). Multivariate logistic regression analysis revealed that ALSS (OR = 0.962, 95% CI 0.951-0.973, P = 0.038), nucleos(t)ide analogs (OR = 0.927, 95% CI 0.871-0.983, P = 0.046), old age (OR = 1.028, 95% CI 1.015-1.041, P < 0.001), total bilirubin (OR = 1.002, 95% CI 1.001-1.003, P = 0.004), INR (OR = 1.569, 95% CI 1.044-2.358, P < 0.001), COSSH-ACLF grade (OR = 2.683, 95% CI 1.792-4.017, P < 0.001), and albumin (OR = 0.952, 95% CI 0.924-0.982, P = 0.002) were independent factors for 28-day mortality.CONCLUSIONS:
The treatment for patients with HBV-ACLF has improved in the past decade.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Hepatitis B, Chronic
/
Acute-On-Chronic Liver Failure
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Hepatitis B
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Humans
Country/Region as subject:
Asia
Language:
En
Year:
2021
Type:
Article