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 clinicalsyndrome with a high mortality rate, which prevails in the Asia-Pacific region. Althoughhigh levelof serum HBV doesn‘t directly insult liver cells antiviral therapy with nucleotideanalogs is of vital importance in the comprehensive treatment of HBV-ACLF.The APASLACLF working committee recommends antiviral therapy to treat HBV relatedacute-on-chronic liver failure (HBV-ACLF) since2009. We previously reported thatEntecavir treatment prevented disease progression in HBV-ACLF patients and establishedthe Tongji prognostic predictor model (TPPM), which is a novel logistical regression model.This study aimed to evaluate the efficacy and safety of Entecavir, Lamivudine andTelbivudine in treating patients with HBV-ACLF and to validate TPPM model in thesepatients.AimThis study aimed to evaluate the efficacy and safety of Entecavir, Lamivudine andTelbivudine in treating patients with HBV-ACLF and to validate TPPM model in thesepatients. MethodIn this retrospective study, we enrolled283patients with HBV-ACLF (100treated withEntecavir,98treated with Lamivudine and85treated with Telbivudine). There were nosignificant differences in baseline clinical and virological characteristics between patientstreated 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%, respectivelyat4weeks and67.00%,65.88%, and73.47%, respectively at12weeks). Patients in all threegroups achieved an improvement of MELD score. Using the Hosmor and Lemeshow test, thevalidation of TPPM for HBV-ACLF demonstrated a good degree of fit with diseaseprognosis. Based on this unique group of patients, the TPPM with an AUC of0.787wassuperior 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-weeksmortality. Using a cutoff of0.22for12-weeks mortality prediction by TPPM, the positivepredictive value was49.66%, with a negative predictive value of89.55%.ConclusionNucleotide analogs including Entecavir, Lamivudine and Telbivudine treatmentprevented disease progression and increased the survival of patients with HBV-ACLF.Patients with cirrhosis were more likely to suffer from complications. Validation of theestablished TPPM scoring system in this study confirmed its superior predictive value forHBV-ACLF patients when compared with MELD.