Influence of metabolic dysfunction-associated fatty liver disease on the prognosis of patients with HBV-related acute-on-chronic liver failure

ABSTRACT

Objectives

Metabolic-associated fatty liver disease (MAFLD) has clinical relevance in patients with acute-on-chronic liver failure (ACLF). We investigated the association between MAFLD and prognosis in patients with ACLF.

Methods

We included patients with ACLF with available clinical data who visited our hospital for nearly 9 years. We compared the prognosis of patients in the different subgroups of ACLF and predicted the incidence of adverse outcomes. Moreover, a new model based on MAFLD was established.

Results

Among 339 participants, 75 had MAFLD. The prognosis of patients with ACLF was significantly correlated with MAFLD. Patients with ACLF with concomitant MAFLD tended to have a lower cumulative survival rate (p = 0.026) and a higher incidence of hepatorenal syndrome (9.33% versus 3.40%, p = 0.033) than those without MAFLD. We developed an TIM2 model and the area under the ROC curve of the new model for 30-day and 60-day mortality (0.759 and 0.748) was higher than other predictive methods.

Conclusion

The presence of MAFLD in patients with HBV-related ACLF was associated with an increased risk of in-hospital mortality. Moreover, The TIM2 model is a high-performance prognostic score for HBV-related ACLF.

GRAPHICAL ABSTRACT

KEYWORDS:

• Fatty liver
• liver failure
• hepatitis B virus
• metabolic disease
• prognosis

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Correction

Abbreviations

ACLF: Acute-on-chronic liver failure; ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; AUGIH: Acute upper gastrointestinal hemorrhage; AMMON: Ammonia; AFP: Alpha fetal protein; AUC: Area under the curve; BMI: Body mass index; BLA: Blood lactic acid; BUN: Blood urea nitrogen; CTP: Child-Turcotte-Pugh; CI: Confidence interval; CKD: Chronic kidney disease; CRP: C-reactive protein; DM: Diabetes mellitus; DNA: Deoxyribonucleic acid; FBG: Fasting blood-glucose; HBV: Hepatitis B virus; HBsAg: Hepatitis B surface antigen; HBeAg: Hepatitis B e antigen; HDL: High density lipoprotein; HE: Hepatic encephalopathy; HRS: Hepatorenal syndrome; HRs: Hazard ratios; INR: International normalized ratio; LDL: Low-density lipoprotein; MELD: Model for End-Stage Liver Disease; MELD-Na: Model for End-Stage Liver Disease with serum sodium; MAFLD: Metabolic associated fatty liver disease; NAFLD: Non-alcoholic fatty liver disease; Na+: Natriumion; PLT: Platelet count; PT: Prothrombin time; SBP: Spontaneous peritonitis;Scr: Serum creatinine; TBIL: Total bilirubin; TCHO: Total cholesterol; TG: Triglyceride; WBC: White blood cell.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors had access to relevant data and approved the final version. Study concept and design (R Lai, Y Zhu, L Yao); acquisition of data (L Yao, Shan Lin, B Liu, Z Liang); statistical analysis and interpretation of data (J Zhou, T Chen, J Jiang); drafting of the manuscript (R Lai, Qi Zheng); critical revision of the manuscript for important intellectual content (R Lai, Y Zhu).

Acknowledgments

All patients who participated in this study are appreciated.

Informed consent statement

Informed consent was waived because of the retrospective nature of the study.

Data sharing statement

All data generated during the project will be made freely available by the corresponding author when reasonably required. There are no security, licensing, or ethical issues related to these data.

Correction Statement

This article was originally published with errors, which have now been corrected in the online version. Please see Correction (http://dx.doi.org/10.1080/17474124.2024.2314810).

Additional information

Funding

This paper was funded by Natural Science Foundation of Fujian Province [No. 2021J01224]; Fujian Province Health Education Joint Project [No. 2019-WJ-16] and Fujian Provincial Health Technology Project [No. 2020CXA040].