Prognostic value of decline in model for end-stage liver disease score and hepatic encephalopathy in hepatitis B-related acute-on-chronic liver failure patients treated with plasma exchange

Abstract

Objective

To investigate the prognostic value of Model for End-Stage Liver Disease (MELD) score and Hepatic Encephalopathy (HE) for short-term prognosis of Hepatitis B virus-related Acute-on-Chronic Liver Failure (HBV-ACLF) patients treated with plasma exchange (PE).

Methods

A total of 108 patients with HBV-ACLF treated with PE were retrospectively enrolled between January 2014 to December 2020. Based on survival at 28 days, patients were divided into survival (N = 87) and death groups (N = 21). Clinical data and laboratory indicators were analyzed.

Results

Compared with the survival group, the death group was associated with higher ACLF grade and incidence of HE. The levels of total bilirubin, prothrombin time, creatinine, blood urea nitrogen, MELD score, and Chinese Group on the Study of Severe Hepatitis B-ACLF II (COSSH II) score were significantly higher in the death group than in the survival group (p < .05). Grade 1 ACLF and the MELD score after PE treatment at one week were independent risk factors for 28-day liver transplantation-free mortality (OR = 0.062, 95%CI: 0.005–0.768; OR = 1.328, 95%CI: 1.153–1.531). A MELD score at one week of at least 25.5 was associated with a poor short-term prognosis. Of note, HE was a strong independent risk factor for a decline in MELD score at one week. (OR = 11.815, 95%CI: 3.187–43.796, p < 0.001).

Conclusion

We found patients with HE at admission and MELD score of at least 25.5 at one week after PE treatment had a poor short-term prognosis and should prompt preparation for liver transplantation. Trial Registration: The trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT04231565). Registered 13 May 2020.

Keywords:

• Hepatitis B virus
• acute-on-chronic liver failure
• plasma exchange
• model for end-stage liver disease score
• mortality

Ethics approval and consent to participate

The study protocol conforms to the ethical principles of the 1975 Declaration of Helsinki (6th revision, 2008), and was approved by the Medical Ethics Committee of the Third Affiliated Hospital of Sun Yat-Sen University (approval number: [2020]02-009-01). All patients provided written informed consent and informed consent was obtained from legal guardians of dead patients for this retrospective study.

Author contributions

All authors contributed to the concept and design, patient recruitment, and follow-up of this study. Lu Wang, Shu Zhu and Ying Liu had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. Lihua Zheng, Wenxiong Xu, Qiumin Luo, Yeqiong Zhang, Hong Deng, Xinhua Li were responsible for the acquisition, analysis, and interpretation of data. Lu Wang drafted the manuscript. Liang Peng and Chan Xie obtained the funding, and took responsibility for the supervision.

Disclosure statement

We certify that none of the authors have any conflicts of interest with regards to this research.

Data availability statement

The data used to support the findings of this study are available from the corresponding author upon request.

Additional information

Funding

This study was supported by grants from the National major science and technology project for the prevention and treatment of AIDS and viral hepatitis (2018ZX10302204-002 to LP, 2018ZX10302205-002 to CX), Natural Science Foundation of China (No. 81873572 to LP, 82070611 to LP), Guangzhou Science and Technology Plan Projects (201904010442 to CX, 202102010204 to LP), Guangdong Science and Technology Plan Projects (2020A1515010317 to CX), Sun Yat-Sen University Clinical Research 5010 Program (2018009 to CX, 2020007 to LP), and the Five-Year Plan of Third Affiliated Hospital of Sun Yat-Sen University (K00006 to LP).