1
|
Effects of Tenofovir Combined with Recombinant Human Interferon α-2b on Negative Conversion Rate, Liver Function, Immune Status, and Drug Safety in Patients with Chronic Hepatitis B: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1889628. [PMID: 35815265 PMCID: PMC9262527 DOI: 10.1155/2022/1889628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 11/18/2022]
Abstract
Objective To systematically evaluate the clinical value of tenofovir combined with recombinant human interferon α-2b in the treatment of chronic hepatitis B and to provide evidence-based medicine for its popularization and use. Methods The randomized controlled trials (RCTs) of tenofovir combined with recombinant human interferon α-2b in the online database of PubMed, EMBASE, ScienceDirect, Cochrane Library, China knowledge Network (CNKI), China VIP database, Wanfang database, and China Biomedical Literature Database (CBM) were searched. The data included in this study were extracted by two independent researchers. After extracting the data of the study, the Cochrane manual 5.1.0 standard was used to evaluate the bias risk of all the literature included in this study. RevMan5.4 statistical software was used to analyze the collected data by meta. Results Entecavir combined with recombinant human interferon α-2b can inhibit the activity of HBV polymerase and improve the inflammatory response of the liver. Recombinant human interferon α-2b can regulate immune function by inducing T cell differentiation and maturation and enhancing the production of cytokines. The systematic evaluation showed that entecavir combined with recombinant human interferon α-2b had higher serum HBeAg negative conversion rate, higher drug safety compared with entecavir alone, and improved liver function and immune status. Conclusion Tenofovir combined with recombinant human interferon alpha-2b has a high serum HBeAg negative rate and safety profile for the treatment of chronic hepatitis B. The combination treatment can improve liver function and immune status in patients, but more studies with higher methodological quality and longer duration of intervention are needed for further validation.
Collapse
|
2
|
Saldaña RS, Schrem H, Barthold M, Kaltenborn A. Prognostic Abilities and Quality Assessment of Models for the Prediction of 90-Day Mortality in Liver Transplant Waiting List Patients. PLoS One 2017; 12:e0170499. [PMID: 28129338 PMCID: PMC5271345 DOI: 10.1371/journal.pone.0170499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/01/2016] [Indexed: 12/28/2022] Open
Abstract
Background Model of end-stage liver disease (MELD)-score and diverse variants are widely used for prognosis on liver transplant waiting-lists. Methods 818 consecutive patients on the liver transplant waiting-list included to calculate the MELD, MESO Index, MELD-Na, UKELD, iMELD, refitMELD, refitMELD-Na, upMELD and PELD-scores. Prognostic abilities for 90-day mortality were investigated applying Receiver-operating-characteristic-curve analysis. Independent risk factors for 90-day mortality were identified with multivariable binary logistic regression modelling. Methodological quality of the underlying development studies was assessed with a systematic assessment tool. Results 74 patients (9%) died on the liver transplant waiting list within 90 days after listing. All but one scores, refitMELD-Na, had acceptable prognostic performance with areas under the ROC-curves (AUROCs)>0.700. The iMELD performed best (AUROC = 0.798). In pediatric cases, the PELD-score just failed to reach the acceptable threshold with an AUROC = 0.699. All scores reached a mean quality score of 72.3%. Highest quality scores could be achieved by the UKELD and PELD-scores. Studies specifically lack statistical validity and model evaluation. Conclusions Inferior quality assessment of prognostic models does not necessarily imply inferior prognostic abilities. The iMELD might be a more reliable tool representing urgency of transplantation than the MELD-score. PELD-score is assumedly not accurate enough to allow graft allocation decision in pediatric liver transplantation.
Collapse
Affiliation(s)
- Ricardo Salinas Saldaña
- Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Harald Schrem
- Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Marc Barthold
- Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
| | - Alexander Kaltenborn
- Core Facility Quality Management & Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
- Department of Trauma and Orthopedic Surgery, Federal Armed Forces Hospital Westerstede, Westerstede, Germany
- * E-mail:
| |
Collapse
|
3
|
Shi X, Zhu P, Yan G, Liu C, Zhang C, Huang G, Zhang Y, Yan Z, Wang Y. Clinical characteristics and long-term outcome of acute kidney injury in patients with HBV-related acute-on-chronic liver failure. J Viral Hepat 2016; 23:920-929. [PMID: 27397610 DOI: 10.1111/jvh.12566] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 06/07/2016] [Indexed: 12/15/2022]
Abstract
Acute kidney injury (AKI) is a common complication in patients with decompensated cirrhosis and is also an important cause for poor outcome. This study aimed at investigating the clinical characteristics and long-term prognosis of AKI in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). A total of 1167 patients with HBV-related ACLF from January 2010 to January 2015 were enrolled and divided into two groups, AKI group (n=308) and non-AKI group (n=859). All patients were followed up to investigate clinical characteristics, long-term overall survival (OS) and risk factors. AKI occurrence was found to be 26.4% in patients with HBV-related ACLF. The patients in the AKI group and the non-AKI group had a 30-day OS of 44.8% and 70.3%, 90-day OS of 17.9% and 55.4%, and 1-year OS of 15.6% and 51.2%, respectively. Significant differences were observed in the 30-day, 90-day and 1-year OS among subgroups with different AKI stages. It was found that high WBC, neutrophil, ALT and MELD score were risk factors for 30-day mortality, whereas hepatic encephalopathy, high MELD score, mean arterial pressure and PLT were risk factors for 90-day mortality. Two criteria, the KDIGO and AKIN, showed parallel results in staging AKI in patients with HBV-related ACLF (κ=0.807, P<.001). AKI is closely associated with increased short-term mortality in Chinese HBV-related ACLF patients, particularly in those with infection and high MELD score. Both KDIGO and AKIN criteria can be used for staging AKI in patients with HBV-related ACLF.
Collapse
Affiliation(s)
- X Shi
- Institute for Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - P Zhu
- Institute for Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - G Yan
- Institute for Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - C Liu
- Institute for Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - C Zhang
- Institute for Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - G Huang
- Institute for Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Y Zhang
- Institute for Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Z Yan
- Institute for Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Y Wang
- Institute for Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China.
| |
Collapse
|
4
|
Yi ZQ, Lu MH, Xu XW, Fu XY, Tan DM. A novel prognostic score for acute-on-chronic hepatitis B liver failure. ACTA ACUST UNITED AC 2015; 35:87-92. [PMID: 25673199 DOI: 10.1007/s11596-015-1394-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 12/31/2014] [Indexed: 12/20/2022]
Abstract
Patients with acute-on-chronic hepatitis B liver failure (HBV-ACLF) show high morbidity and mortality. Independent prognostic predictors of short-term HBV-ACLF mortality include the Child-Turcotte-Pugh (CTP) score, the model for end-stage liver disease (MELD) score, other MELD-based indices and the dynamic changes in these indices. The aims of this study were to evaluate the existing prognostic scores in a large cohort of HBV-ACLF patients and create a new predictive model. We retrospectively reviewed 392 HBV-ACLF patients from December 2008 to November 2011 and evaluated their 3-month survival. The predictive accuracy of CTP, MELD and MELD-based indices and the dynamic changes in the MELD-related scores (Δ scoring systems) upon admission and after two weeks of treatment were compared using the area under the receiver operating characteristic (ROC) curve method. Life-threatening factors and a series of bio-clinical parameters were studied by univariate and multivariate analyses. Among the existing scores, MELD had the best predictive ability. However, our new regression model provided an area under the curve of 0.930 ± 0.0161 (95% CI: 0.869 to 0.943), which was significantly larger than that obtained with the MELD score at admission and after two weeks of treatment as well as with the dynamic changes of the MELD score (0.819, 0.921, and 0.826, respectively) (Z=3.542, P=0.0004). In a large cohort of patients retrospectively reviewed for this study, our prognostic model was superior to the MELD score and is, therefore, a promising predictor of short-term survival in patients with HBV-ACLF.
Collapse
Affiliation(s)
- Zhao-Quan Yi
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Meng-Hou Lu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Xu-Wen Xu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Xiao-Yu Fu
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - De-Ming Tan
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, 410008, China.
| |
Collapse
|
5
|
Xun YH, Shi JP, Li CQ, Li D, Shi WZ, Pan QC, Guo JC, Zang GQ. Prognostic performance of a series of model for end-stage liver disease and respective Δ scores in patients with hepatitis B acute-on-chronic liver failure. Mol Med Rep 2014; 9:1559-68. [PMID: 24573151 PMCID: PMC4020485 DOI: 10.3892/mmr.2014.1983] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 02/07/2014] [Indexed: 12/12/2022] Open
Abstract
The present study aimed to compare the short-term prognostic performance of a series of model for end-stage liver disease (MELD) and respective delta (Δ) scores scoring systems in a population with acute-on-chronic hepatitis B liver failure (ACHBLF), and to investigate the potential effects from antivirals. A total of 77 patients with ACHBLF of mean age 46 years, 82% male, with 58.4% receiving antivirals, were recruited for this study. The Δ scores for MELDs were defined as the changes one week after admission. Thirty-eight (49%) patients (22 treated with antivirals) died within three months. The mean MELD and ΔMELD scores of the survival group were 19.5±4.4 and 0.2±3.7 respectively, and those of the mortality group were 23.5±5.5 and 7.9±6, respectively. The area under the receiver operating characteristic curve (AUC) for MELD, integrated MELD (iMELD), MELD with the addition of serum sodium (MELD-Na), updated MELD (upMELD), MELD excluding the international normalized ratio (INR; MELD-XI), United Kingdom MELD (UKMELD) and their Δ scores were 0.72, 0.81, 0.77, 0.69, 0.65, 0.77 and 0.86, 0.83, 0.83, 0.82, 0.79 and 0.79, respectively. iMELD and MELD-Na significantly improved the accuracy of MELD (P<0.05). A cut-off value of 41.5 for the iMELD score can prognose 71% of mortalities with a specificity of 85%. In each pair of models, the Δ score was superior to its counterpart, particularly when applied to patients with MELD ≤30. Decreased accuracy was observed for all models in the subset of patients treated with antivirals, although their baseline characteristics were comparable to those of untreated patients, while iMELD, MELD-Na and respective Δ models remained superior with regard to the predictability. The iMELD and MELD-Na models predicted three-month mortality more accurately, while the Δ models were superior to their counterparts when MELD ≤30; however, their performance was altered by antivirals, and thus requires optimization.
Collapse
Affiliation(s)
- Yun-Hao Xun
- Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China
| | - Jun-Ping Shi
- Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China
| | - Chun-Qing Li
- Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China
| | - Dan Li
- Department of Infectious Diseases, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, P.R. China
| | - Wei-Zhen Shi
- Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China
| | - Qing-Chun Pan
- Department of Infectious Diseases, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, P.R. China
| | - Jian-Chun Guo
- Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China
| | - Guo-Qing Zang
- Department of Infectious Diseases, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, P.R. China
| |
Collapse
|
6
|
|
7
|
Abolghasemi J, Eshraghian MR, Nasiri Toosi M, Mahmoodi M, Rahimi Foroushani A. Introducing an optimal liver allocation system for liver cirrhosis patients. HEPATITIS MONTHLY 2013; 13:e10479. [PMID: 24098306 PMCID: PMC3787686 DOI: 10.5812/hepatmon.10479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 02/08/2013] [Accepted: 02/20/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Liver transplantation (LT) is the only treatment option for patients with advanced liver disease. Currently, liver donation to these patients, considering priorities, is based on the Model for End-Stage Liver Disease (MELD). MELD score is a tool for predicting the risk of mortality in patients with advanced liver disease. However, few studies have so far been conducted in Iran on the efficacy of MELD score of these patients. OBJECTIVES This study reviews the present status of the MELD score and introduces a new model for optimal prediction of the risk of mortality in Iranian patients with advanced liver disease. PATIENTS AND METHODS Data required were collected from 305 patients with advanced liver disease who enrolled in a waiting list (WL) in Imam Khomeini Hospital from May 2008 to May 2009. All of the patients were followed up for at least 3 years until they died or underwent LT. Cox regression analysis was applied to select the factors affecting their mortality. Survival curves were plotted. Wilcoxson test and receiver operating characteristics curves for survival predictive model were used to compare the scores. All calculations were performed with the SPSS (version 13.0) and R softwares. RESULTS During the study, 71 (23.3%) patients died due to liver cirrhosis and 43 (14.1%) underwent LT. Viral Hepatitis (43.7%) is the most common cause of end-stage liver disease among Iranian patients. A new model (NMELD) was proposed with the use of the natural logarithms of two blood serum variables (total bilirubin and albumin) and the patients' age (year) by applying the Cox model: NMELD = 10 × (0.736 × ln (bilirubin) - 1.312 × ln (albumin) + 0.025 × age + 1.776). CONCLUSIONS The results of the Wilcoxon test showed that there is a significant difference between the usual MELD and our proposed NMELD scores (P < 0.001). Receiver operating characteristics curve for survival predictive model indicated that the NMELD score is more efficient compared with the MELD score in predicting the risk of mortality. Since serum creatinine was not significant in NMELD score, further studies to clarify this issue are suggested.
Collapse
Affiliation(s)
- Jamileh Abolghasemi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Reza Eshraghian
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohammad Reza Eshraghian, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2188989127, Fax: +98-2188989127, E-mail:
| | - Mohsen Nasiri Toosi
- Department of Gastroenterology, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mahmood Mahmoodi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
8
|
|