| Hepatitis B infection remains a major health problem in many regions around the world. An estimated 400 million people worldwide carry the hepatitis B virus (HBV) and about 5% of those who become infected will die as a consequence of cirrhosis (severe liver scarring) and liver cancer. Because of the discordance of etiologic factors and standard diagnosis in China and other countries, the prognosis of acute liver failure is different. At present liver transplantation is the unique effective therapy for liver failure. But donors of liver transplantation are limited and scare, it is difficult to carry out liver transplantations. Another important issue is how to select the time of liver transplantation. There are some standard of liver transplantation in other countries, for example, KCH and MELD, etc. But there is no such standard in China now. Antiviral and artificial liver support therapy can improve clinical symptoms of liver failure, but there is no evidence that these therapies can increase the long term survival.In addition, there is no effective system of registration and management for cases of liver failure and no observation and follow-up of standard therapy, so it is no chance to carry out large scaled and multiple center cooperation. It is significant to build up shared network database of inpatients'information of liver failure. The database will help physicians diagnose and treat this disease and increase the research level of our country.Based on these mentioned issues, we execute the following studies. First, we described, analyzed and evaluated the KCH and MELD confer to new standard of acute liver failure diagnosis; second, we evaluated the consequences of antiviral and artificial liver support treatment in patients with patients with acute on chronic liver failure due to hepatitis B. lastly, we build up network database of liver failure.The Main Research Results1. A total of 323 in patients with ALF were identified. The most common cause of ALF was HBV induced in 83.6% and drugs in 5%. In 20 cases(7.0%) no definite etiology could be established. The KCH criteria had a positive predictive value (PPV) of 89.4%, negative predictive value (NPV) of 38% respectively. MELD score>27 had a positive predictive value of 89.5%, negative predictive value of 45.6%. The KCH criteria had a predictive accuracy of 66.2% lower than that of 77.9% which MELD score had.2. A total of 206 inpatients with acute on chronic liver failure induced by hepatitis B were enrolled in this study. Cases were patients who received lamivudine treatment (n=103).Controls were patients who did not receive lamivudine treatment (n=103). The median survival time in lamivudine treatment group and control group were 85 days, 35 days respectively. The survival rate for 3 years in treatment group and control group were 42.7%, 23.4% respectively. There was significance difference in survival rate between the two groups (P<0.01).Besides age, total bilirubin, prothrombin time, international normalized ratio, leukocyte and creatinine, the serum HBV level and the serum sodium level are important prognostic factor, the risk ratio(RR) were 2.347 and 0.023, respectively.3. A total of 56 inpatients with acute on chronic liver failure induced by hepatitis B were enrolled in this study. The match was conducted according with age,hepatic encephalopathy and MELD score. The match ratio was 1:1. Cases were patients who receive artificial liver support system (ALSS) treatment (n=28), Controls were patients who did not receive ALSS treatment (n=28). After 53 times ALSS treatment among the 28 patients, the clinical symptoms and signs of all patients were ameliorated at the MELD were significant decreased. (P <0.001). The survival rate in ALSS treatment group for 1,3 and 6 month was 67.2%, 35.7% and 32.1% respectively. That in control group was 57.1%, 28.6% and 25.0%. There is no significant difference in survival rate were observed between the two groups (P>0.05).4. The clinical data web database of liver failure was established. The preliminary trial of data communication via internet show to be stable and fluent, information storage to be convenient and complete, result of query to be perfect and credible, data output to be accurate.Conclusion1. HBV infection was the most common cause in unselected patients with ALF in China. Both KCH criteria and MELD score <27 had a high PPV and lower NPV and MELD had higher predictive accuracy compared with KCH criteria.2. Lamivudine may improve long term survival of patients with chronic hepatitis B suffering from acute on chronic liver failure.3. ALSS can improve effectively the condition of patients with acute on chronic liver failure and decrease MELD score significantly. Unfortunately it may not improve the survival rate.4. The web database system which was stable and safe could not only provide support for clinical data digitization storage and web sharing, but also increase efficiency and quality of clinically research. The system would have important clinical application significance and have a prosperous future.
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