title: Dynamic changes of clinical features that predict the prognosis of acute-on-chronic hepatitis B liver failure: a retrospective cohort study.
abstract: OBJECTIVE
  The natural history of acute-on-chronic hepatitis B liver failure (ACHBLF) is complex and highly variable. However, the global clinical characteristics of this entity remain ill-defined. We aimed to investigate the dynamic patterns of the natural progression as well as their impact on the outcomes of ACHBLF.
  
  
  METHODS
  The clinical features and disease states were retrospectively investigated in 54 patients with ACHBLF at the China South Hepatology Center. The clinical and laboratory profiles including hepatic encephalopathy (HE), hepatorenal syndrome (HRS), and spontaneous bacterial peritonitis (SBP) were evaluated. The disease state estimated by the model for end-stage liver disease (MELD) score and the dynamic patterns during the clinical course of ACHBLF were extrapolated.
  
  
  RESULTS
  Twenty-two patients died during the 3-month follow-up period (40.74%). The patients were predominantly male (88.89%). Baseline characteristics showed that there were significant differences in only hepatitis B virus (HBV) DNA levels and platelet count between the deceased and surviving patients (P=0.014 and P=0.012, respectively). Other baseline characteristics were similar in both groups. The dynamic state of the MELD score gradually increased from an initial hepatic flare until week 4 of ACHBLF progression. There were notable changes of the dynamic state of the MELD score at two time points (week 2 and week 4) during ACHBLF progression. The MELD scores were significantly greater in the death group (24.80 ± 2.99) than in the survival group (19.49±1.96, P<0.05) during the clinical course of ACHBLF; the MELD scores of the survival group began to decrease from week 4, while they continued to rise and eventually decreased as more patients died. The gradients of the ascent and descent stages could predict exactly the severity and prognosis of ACHBLF.
  
  
  CONCLUSIONS
  The natural progression of ACHBLF could be divided approximately into four stages including ascent, plateau, descent, and convalescence stages according to different trends of liver failure progression, respectively. Thus, the special patterns of the natural progression of ACHBLF may be regarded as a significant predictor of the 3-month mortality of ACHBLF.
authors.affiliation: 1. Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University; ; 2. Key Laboratory of Tropical Disease Control (Sun Yat-Sen University), Ministry of Education, Guangdong, China. No 600 Tianhe Road, Guangzhou 510630, Guangdong Province, PR China.
authors.forename: Yu-Bao
authors.initials: YB
authors.lastname: Zheng
authors.forename: Zhan Lian
authors.initials: ZL
authors.lastname: Huang
authors.forename: Zhe Bin
authors.initials: ZB
authors.lastname: Wu
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.forename: Yu Rong
authors.initials: YR
authors.lastname: Gu
authors.forename: Yu Jie
authors.initials: YJ
authors.lastname: Su
authors.forename: Chao Shuang
authors.initials: CS
authors.lastname: Lin
authors.forename: Rui Hua
authors.initials: RH
authors.lastname: Zhu
authors.forename: Bin Liang
authors.initials: BL
authors.lastname: Lin
authors.forename: Zhi Liang
authors.initials: ZL
authors.lastname: Gao
mesh_terms: D000328:Adult; D002681:China; D018450:Disease Progression; D005260:Female; D006515:Hepatitis B virus / Q000472:pathogenicity; D019694:Hepatitis B, Chronic / Q000150:complications / Q000473:pathology* / Q000821:virology; D006801:Humans; D017114:Liver Failure, Acute / Q000150:complications / Q000473:pathology* / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Acute-on-chronic hepatitis B liver failure; Clinical features; Dynamic patterns; Prognosis; and MELD score.