Comparative Analysis Of Risk Factors And Prognosis Of Chronic Acute Liver Failure Induced By Chronic Hepatitis B Recurrence After Discontinuation Of Nucleoside(acid)drugs And Initial Treatment Of Chronic Hepatitis B

Background and Objective To compare the clinical characteristics and prognosis of patients with acute-on-chronic liver failure(ACLF),after withdrawal of nucleoside(acid)analogues and patients with chronic hepatitis B associated acute-on-chronic liver failure(ACLF),and to analyze the prognostic factors in the population.MethodsThis study collected patients with ACLF who visited the first hospital of fujian medical university Meng Chao hospital of fujian medical university and Shanghai Huashan Hospital Fudan University from September 2013 to December 2020.207 patients were included as the na?ve group and 112 patients as the withdrawal group.Collect and analyze the clinical data of patients,telephone follow-up to determine the survival of patients.The baseline clinical indicators,complications,mortality and other prognosis of the two groups were compared,and the prediction model of the overall population prognosis was constructed.Results1.Baseline characteristics: the mean age of the na?ve group was 46.8±13.5 years old,57.5%had cirrhosis,and 43.3% were HBe Ag-positive patients;In the withdrawal group,the mean age was 47.3±11.8 years,67.0% had cirrhosis,and 55.8% were HBe Ag positive patients.The levels of ALB,ALT,CHE,GGT,TCHO,Na+ and PLT in the withdrawal group were significantly lower than those in the na?ve group.The proportion of ACLF patients complicated with infection in the withdrawal group was 60.6%,and the proportion of na?ve group with infection was 25.4%.The overall mortality in the withdrawal group(64.0%)was also significantly higher than that in the na?ve group(41.7%),P <0.001.Propensity score matching was performed for the two groups of patients,including age,gender,HBe Ag status,cirrhosis or not.After PSM,the overall mortality rate of the withdrawal group(63.4%)was still higher than that of the na?ve group(38.8%),and the infection rate of patients with ACLF caused by discontinuation was also higher than that of the na?ve group,which was consistent with the situation observed before PAM in the cohort.2.Kaplan-Meier survival analysis showed that an increase in overall mortality was observed with drug withdrawal recurrence of ACLF,before and after the PSM adjustment for confounding.3.Univariate and multivariate analysis show that: liver failure with discontinuation of NUCS(HR=1.90,95%CI:1.24-2.92,P=0.0031)、age(HR=1.03,95%CI: 1.02-1.05,P=0.0003)、MELD score(HR=1.04,95%CI:1.01-1.08,P=0.0227)and presence of hepatic encephalopathy(HR=4.64,95%CI:2.90-7.41,P=0.001)were independent risk factors of hepatitis B related ACLF.Multivariate analysis in the withdrawal group showed that age(HR=1.03,95%CI:1.00-1.06,P=0.0446)and presence of hepatic encephalopathy(HR=3.1,95%CI:1.4-6.7,P=0.0029)were independent risk factors for ACLF.The type of NUCS before withdrawal and the time of taking NUCS had no significant effect on the survival rate of patients with ACLF caused by relapse after withdrawal.4.The MELD scoring model has limited predictive power in patients with chronic and acute liver failure caused by discontinuation of NUCs,ROC is 0.577,and the predictive power of a new model based on age and whether hepatic encephalopathy occurs is better.ROC-AUC is 0.841,the best threshold It is 0.553,the specificity is 86.67%,the sensitivity is 70.91%,the positive predictive value is 90.7%,and the negative predictive value is61.9%.Including age,whether with hepatic encephalopathy,ACLF and MELD score can predict the overall prognosis of the population.Conclusions1.ACLF patients with recurrence after stopping NUCs are more severely ill,have a higher mortality rate,and have a higher proportion of infections than ACLF patients who were newly treated with hepatitis B-related ACLF.ACLF caused by discontinuation of NUCs,hepatic encephalopathy,age and MELD score are independent risk factors for patients.The cumulative survival rate of ACLF patients caused by discontinuation of NUCs recurrence is significantly lower than that of newly treated hepatitis B-related ACLF patients,regardless of whether they have liver cirrhosis or not.2.The MELD scoring model has limited predictive ability in patients with chronic and acute liver failure caused by discontinuation of NUCs,and the new model based on age and whether hepatic encephalopathy has a better predictive ability.Including age,whether with hepatic encephalopathy,ACLF and MELD score can predict the overall prognosis of the population.