A Clinical Study Of Nucleoside Analogues Treatment In Patients With HBV Related Acute-On-Chronic Liver Failure

BackgroundHBV-ACLF (HBV related acute-on-chronic liver failure) is a specific clinical syndrome with a high mortality rate, which prevails in the Asia-Pacific region. Although high level of serum HBV doesn’t directly insult liver cells antiviral therapy with nucleotide analogs is of vital importance in the comprehensive treatment of HBV-ACLF.The APASL ACLF working committee recommends antiviral therapy to treat HBV related acute-on-chronic liver failure (HBV-ACLF) since2009. We previously reported that Entecavir treatment prevented disease progression in HBV-ACLF patients and established the Tongji prognostic predictor model (TPPM), which is a novel logistical regression model. This study aimed to evaluate the efficacy and safety of Entecavir, Lamivudine and Telbivudine in treating patients with HBV-ACLF and to validate TPPM model in these patients.AimThis study aimed to evaluate the efficacy and safety of Entecavir, Lamivudine and Telbivudine in treating patients with HBV-ACLF and to validate TPPM model in these patients. MethodIn this retrospective study, we enrolled283patients with HBV-ACLF (100treated with Entecavir,98treated with Lamivudine and85treated with Telbivudine). There were no significant differences in baseline clinical and virological characteristics between patients treated with Entecavir, Telbivudine or Lamivudine.ResultsThere were no significant differences in the4and12-week survival rates of Entecavir, Telbivudine and Lamivudine-treated patients (79.00%,81.18%, and86.73%, respectively at4weeks and67.00%,65.88%, and73.47%, respectively at12weeks). Patients in all three groups achieved an improvement of MELD score. Using the Hosmor and Lemeshow test, the validation of TPPM for HBV-ACLF demonstrated a good degree of fit with disease prognosis. Based on this unique group of patients, the TPPM with an AUC of0.787was superior to MELD which had an AUC of0.736in the prediction of12-weeks mortality. TPPM had an AUC of0.733and MELD had an AUC of0.672in the prediction of4-weeks mortality. Using a cutoff of0.22for12-weeks mortality prediction by TPPM, the positive predictive value was49.66%, with a negative predictive value of89.55%.ConclusionNucleotide analogs including Entecavir, Lamivudine and Telbivudine treatment prevented disease progression and increased the survival of patients with HBV-ACLF. Patients with cirrhosis were more likely to suffer from complications. Validation of the established TPPM scoring system in this study confirmed its superior predictive value for HBV-ACLF patients when compared with MELD.