title: Lamivudine improves short-term outcome in hepatitis B virus-related acute-on-chronic liver failure patients with a high model for end-stage liver disease score.
abstract: OBJECTIVE
  Hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) has significant morbidity and mortality. There is no standard approach for the management of HBV-related ACLF with nucleos(t)ide analogs. Our objective was to compare the short-term mortality between entecavir (ETV) and lamivudine (LAM) in patients with HBV-related ACLF.
  
  
  METHODS
  We recruited 311 inpatients with HBV-related ACLF from December 2002 to January 2015. The patients were treated with ETV (n=143) or LAM (n=168). The primary endpoint was mortality rate at week 8. Virological and biochemical responses were also studied.
  
  
  RESULTS
  By week 8, 53 (37.06%) patients in the ETV group and 57 (33.93%) patients in the LAM group died, and the two groups had similar mortality (P=0.414). Multivariate analysis showed that age, total bilirubin, international normalized ratio, and model for end-stage liver disease (MELD) score were independent factors for mortality at week 8. The best cut-off value of the MELD score was 24.5 for 8-week mortality. Twenty-nine of the 170 (17.06%) patients with MELD score less than 24.5 died at week 8, and the ETV and LAM groups had similar mortality (P=0.743). Eighty-one of the 141 (57.45%) patients with MELD score of at least 24.5 died at week 8 and the LAM group had lower mortality than the ETV group (P=0.018 at week 4; P=0.039 at week 8). Both groups showed similar virological and biochemical responses at 4 weeks.
  
  
  CONCLUSIONS
  LAM reduces the 8-week mortality rate significantly in patients with HBV-related ACLF who had MELD score of at least 24.5.
authors.affiliation: aCenter of Integrative Medicine bIntensive Care Unit cInstitute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University dPeking University Hepatology Institute, Peking University People's Hospital, Beijing, China.
authors.forename: Xiaoshu
authors.initials: X
authors.lastname: Li
authors.forename: Fangyuan
authors.initials: F
authors.lastname: Gao
authors.forename: Huimin
authors.initials: H
authors.lastname: Liu
authors.forename: Henghui
authors.initials: H
authors.lastname: Zhang
authors.forename: Yao
authors.initials: Y
authors.lastname: Liu
authors.forename: Xieqiong
authors.initials: X
authors.lastname: Ye
authors.forename: Mingfan
authors.initials: M
authors.lastname: Geng
authors.forename: Le
authors.initials: L
authors.lastname: Sun
authors.forename: Rui
authors.initials: R
authors.lastname: Wang
authors.forename: Yuxin
authors.initials: Y
authors.lastname: Li
authors.forename: Yuyong
authors.initials: Y
authors.lastname: Jiang
authors.forename: Xiaojing
authors.initials: X
authors.lastname: Wang
authors.forename: Guiqin
authors.initials: G
authors.lastname: Zhou
authors.forename: Zhiyun
authors.initials: Z
authors.lastname: Yang
authors.forename: Ang
authors.initials: A
authors.lastname: Li
authors.forename: Hui
authors.initials: H
authors.lastname: Zeng
authors.forename: Xianbo
authors.initials: X
authors.lastname: Wang
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003661:Decision Support Techniques; D024882:Drug Resistance, Viral; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D005260:Female; D006147:Guanine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D019259:Lamivudine / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D019259:Lamivudine; C413685:entecavir; D006147:Guanine