title: Characteristics, Diagnosis and Prognosis of Acute-on-Chronic Liver Failure in Cirrhosis Associated to Hepatitis B.
abstract: The diagnostic and prognostic criteria of acute-on-chronic liver failure (ACLF) were developed in patients with no Hepatitis B virus (HBV) cirrhosis (CANONIC study). The aims of this study were to evaluate whether the diagnostic (CLIF-C organ failure score; CLIF-C OFs) criteria can be used to classify patients; and the prognostic score (CLIF-C ACLF score) could be used to provide prognostic information in HBV cirrhotic patients with ACLF. 890 HBV associated cirrhotic patients with acute decompensation (AD) were enrolled. Using the CLIF-C OFs, 33.7% (300 patients) were diagnosed as ACLF. ACLF was more common in the younger patients and in those with no previous history of decompensation. The most common organ failures were 'hepatic' and 'coagulation'. As in the CANONIC study, 90-day mortality was extremely low in the non-ACLF patients compared with ACLF patients (4.6% vs 50%, p < 0.0001). ACLF grade and white cell count, were independent predictors of mortality. CLIF-C ACLFs accurately predicted short-term mortality, significantly better than the MELDs and a disease specific score generated for the HBV patients. Current study indicates that ACLF is a clinically and pathophysiology distinct even in HBV patients. Consequently, diagnostic criteria, prognostic scores and probably the management of ACLF should base on similar principles.
authors.affiliation: Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.|Shanghai Institute of Digestive Disease, Shanghai, China.|Key Laboratory of Gastroenterology &Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.|Shanghai Institute of Digestive Disease, Shanghai, China.|Key Laboratory of Gastroenterology &Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
authors.forename: Liu-Ying
authors.initials: LY
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.|Shanghai Institute of Digestive Disease, Shanghai, China.|Key Laboratory of Gastroenterology &Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
authors.forename: Nan-Nan
authors.initials: NN
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.|Shanghai Institute of Digestive Disease, Shanghai, China.|Key Laboratory of Gastroenterology &Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
authors.forename: Shu-Ting
authors.initials: ST
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.|Shanghai Institute of Digestive Disease, Shanghai, China.|Key Laboratory of Gastroenterology &Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Zeng
authors.affiliation: Data Management Centre, European Foundation for the study of Chronic LIver Failure (EF-CLIF), Barcelona, Spain.
authors.forename: Marco
authors.initials: M
authors.lastname: Pavesi
authors.affiliation: Data Management Centre, European Foundation for the study of Chronic LIver Failure (EF-CLIF), Barcelona, Spain.
authors.forename: Àlex
authors.initials: À
authors.lastname: Amorós
authors.affiliation: Liver Failure Group, Institute for Liver and Digestive Health, UCL, London, United Kingdom.
authors.forename: Rajeshwar P
authors.initials: RP
authors.lastname: Mookerjee
authors.affiliation: Department of Liver Surgery and Liver Transplantation, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Xia
authors.affiliation: Department of Liver Surgery and Liver Transplantation, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Xue
authors.affiliation: Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.|Shanghai Institute of Digestive Disease, Shanghai, China.|Key Laboratory of Gastroenterology &Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
authors.forename: Xiong
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.|Shanghai Institute of Digestive Disease, Shanghai, China.|Key Laboratory of Gastroenterology &Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Hua
authors.affiliation: Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.|Shanghai Institute of Digestive Disease, Shanghai, China.|Key Laboratory of Gastroenterology &Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
authors.forename: Li
authors.initials: L
authors.lastname: Sheng
authors.affiliation: Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.|Shanghai Institute of Digestive Disease, Shanghai, China.|Key Laboratory of Gastroenterology &Hepatology, Chinese Ministry of Health (Shanghai Jiao Tong University), Shanghai, China.
authors.forename: De-Kai
authors.initials: DK
authors.lastname: Qiu
authors.affiliation: Department of Infectious Disease, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Xie
authors.affiliation: Queen Mary's University of London, Barts Health, United Kingdom.
authors.forename: Graham R
authors.initials: GR
authors.lastname: Foster
authors.affiliation: Liver Failure Group, Institute for Liver and Digestive Health, UCL, London, United Kingdom.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Dusheiko
authors.affiliation: Service d'Hepatologie, Hopital Beaujon, Clichy, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Moreau
authors.affiliation: Liver Unit, Hospital Clinic, Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Gines
authors.affiliation: Liver Unit, Hospital Clinic, Barcelona, Spain.|European Foundation for the study of Chronic Liver Failure (EF-CLIF), Barcelona, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
authors.affiliation: Liver Failure Group, Institute for Liver and Digestive Health, UCL, London, United Kingdom.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jalan
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D004279:DNA, Viral / Q000235:genetics*; D003937:Diagnosis, Differential; D005260:Female; D006515:Hepatitis B virus / Q000235:genetics / Q000472:pathogenicity; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D006801:Humans; D007958:Leukocyte Count; D008099:Liver / Q000473:pathology* / Q000821:virology; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D004279:DNA, Viral