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Cooper KM, Colletta A, Osorio B, Herringshaw E, Talat A, Devuni D. History of Depression is Associated With Higher Prevalence of Hepatic Encephalopathy in Patients With Advanced Liver Disease. Am J Med 2024:S0002-9343(24)00275-4. [PMID: 38729591 DOI: 10.1016/j.amjmed.2024.04.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Depression and hepatic encephalopathy are common in patients with advanced liver disease. Although these are distinct entities, they share several clinical features. In this analysis, we evaluated whether having a history of depression was associated with developing hepatic encephalopathy in patients with advanced liver disease. METHODS We performed a retrospective cohort study of patients with cirrhosis referred for liver transplant. Patients were categorized into 1 of 2 groups: "history of depression" or "no history of depression." Multivariable logistic regression was used to evaluate history of depression as a potential independent predictor of hepatic encephalopathy. RESULTS A total of 447 patients were included, of which 158 (35%) had a history of depression and 233 (52%) had experienced hepatic encephalopathy. Hepatic encephalopathy was more common in patients with a history of depression (63% vs 46%, P < .01). On multivariate analyses, depression history was independently associated with hepatic encephalopathy (aOR 2.3, 95% CI 1.4-3.6), along with alcohol associated cirrhosis (aOR 2.0, 95% CI 1.3-3.2), history of ascites (aOR 3.5, 95% CI 2.1-5.9) and presence of a trans-jugular intra-hepatic shunt (aOR 9.2, 95% CI 2.6-32.6). The relationship between history of depression and hepatic encephalopathy remained significant in a subgroup of patients with alcohol associated liver disease (P = .04). Among those with a history of depression, SNRI prescription was more common in the hepatic encephalopathy group (14% vs 3%), and SNRI prescription was as an independent predictor of hepatic encephalopathy in the multivariable model (OR 4.8, 95% CI 1.0-24.6) CONCLUSIONS: Patients with a history of depression were significantly more likely to experience hepatic encephalopathy. Patients with cirrhosis who have a history of depression should be closely monitored for the development of hepatic encephalopathy. Further research is needed to understand the nuances of this relationship and whether the use of certain psychiatric medications may modify the relationship between depression and hepatic encephalopathy.
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Affiliation(s)
- Katherine M Cooper
- Department of Medicine, University of Mass Chan Medical School, Worcester, Mass
| | - Alessandro Colletta
- Department of Medicine, University of Mass Chan Medical School, Worcester, Mass
| | - Brian Osorio
- Department of Medicine, University of Mass Chan Medical School, Worcester, Mass
| | - Emilee Herringshaw
- Department of Medicine, University of Mass Chan Medical School, Worcester, Mass
| | - Arslan Talat
- Department of Medicine, University of Mass Chan Medical School, Worcester, Mass; Division of Gastroenterology and Hepatology, Department of Medicine, UMass Chan Medical School, Worcester, Mass
| | - Deepika Devuni
- Department of Medicine, University of Mass Chan Medical School, Worcester, Mass; Division of Gastroenterology and Hepatology, Department of Medicine, UMass Chan Medical School, Worcester, Mass.
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3
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Qiu S, Zhang Q, Hu J, Wang L, Chen R, Cao Y, Liu F, Yu Z, Zhao C, Zhang L, Ren W, Xin S, Chen Y, Duan Z, Han T. Impact of Onset Time, Number, Type, and Sequence of Extrahepatic Organ Failure on Prognosis of Acute-on-chronic Liver Failure. J Clin Transl Hepatol 2024; 12:257-265. [PMID: 38426199 PMCID: PMC10899869 DOI: 10.14218/jcth.2023.00379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/02/2023] [Accepted: 12/18/2023] [Indexed: 03/02/2024] Open
Abstract
Background and Aims The impact of the characteristics of extrahepatic organ failure (EHOF) including the onset time, number, type, and sequence on the prognosis of acute-on-chronic liver failure (ACLF) patients remains unknown. This study aimed to identify the association between the characteristics of EHOF and the prognosis of ACLF patients. Methods ACLF subjects enrolled at six hospitals in China were included in the analysis. The risk of mortality based on the characteristics of EHOF was evaluated. Survival of study groups was compared by Kaplan-Meier analysis and log-rank tests. Results A total of 736 patients with ACLF were included. EHOF was observed in 402 patients (54.6%), of which 295 (73.4%) developed single EHOF (SEHOF) and 107 (26.6%) developed multiple EHOF (MEHOF). The most commonly observed EHOF was coagulation failure (47.0%), followed by renal (13.0%), brain (4.9%), respiratory (4.3%), and circulatory (2.3%) failure. Survival analysis found that MEHOF or SEHOF patients with brain failure had a worse prognosis. However, no significant outcome was found in the analysis of the effect of onset time and sequence of failed organs on prognosis. Patients were further divided into three risk subgroups by the EHOF characteristics. Kaplan-Meier analysis showed that risk stratification resulted in the differentiation of patients with different risks of mortality both in the training and validation cohorts. Conclusions The mortality of ACLF patients was determined by the number and type, but not the onset time and sequence of EHOF. Risk stratification applicable to clinical practice was established.
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Affiliation(s)
- Shaotian Qiu
- The School of Medicine, Nankai University, Tianjin, China
- Department of Gastroenterology and Hepatology, Tianjin Union Medical Center Affiliated to Nankai University, Tianjin, China
| | - Qian Zhang
- Department of Gastroenterology and Hepatology, Tianjin Union Medical Center, Tianjin, China
- Tianjin Medical University, Tianjin, China
| | - Jiaxuan Hu
- The School of Medicine, Nankai University, Tianjin, China
- Department of Gastroenterology and Hepatology, Tianjin Union Medical Center Affiliated to Nankai University, Tianjin, China
| | - Lewei Wang
- Department of Gastroenterology and Hepatology, Tianjin Union Medical Center of Tianjin Medical University, Tianjin, China
| | - Rui Chen
- Department of Gastroenterology and Hepatology, Tianjin Union Medical Center of Tianjin Medical University, Tianjin, China
| | - Yingying Cao
- Department of Hepatology and Gastroenterology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Fang Liu
- Department of Hepatology and Gastroenterology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
| | - Zhenjun Yu
- Department of Gastroenterology and Hepatology, Tianjin Union Medical Center, Tianjin, China
| | - Caiyan Zhao
- Department of Infectious Disease, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Liaoyun Zhang
- Department of Infection Disease, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wanhua Ren
- Infectious Department of Shandong First Medical University Affiliated Shandong Provincial Hospital, Jinan, Shandong, China
| | - Shaojie Xin
- Liver Failure Treatment and Research Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yu Chen
- Liver Disease Center (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You’an Hospital Affiliated to Capital Medical University, Beijing, China
| | - Zhongping Duan
- Liver Disease Center (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You’an Hospital Affiliated to Capital Medical University, Beijing, China
| | - Tao Han
- The School of Medicine, Nankai University, Tianjin, China
- Department of Gastroenterology and Hepatology, Tianjin Union Medical Center Affiliated to Nankai University, Tianjin, China
- Department of Gastroenterology and Hepatology, Tianjin Union Medical Center, Tianjin, China
- Tianjin Medical University, Tianjin, China
- Department of Gastroenterology and Hepatology, Tianjin Union Medical Center of Tianjin Medical University, Tianjin, China
- Department of Hepatology and Gastroenterology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
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4
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Zou J, Li H, Deng G, Wang X, Zheng X, Chen J, Meng Z, Zheng Y, Gao Y, Qian Z, Liu F, Lu X, Shi Y, Shang J, Huang Y, Chen R. A novel prognostic nomogram for older patients with acute-on-chronic liver diseases (AoCLD): a nationwide, multicentre, prospective cohort study. Age Ageing 2023; 52:6974854. [PMID: 36626326 PMCID: PMC9831261 DOI: 10.1093/ageing/afac313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 11/03/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND the incidence of acute-on-chronic liver disease (AoCLD) is increasing. OBJECTIVE to investigate the clinical features and risk factors of AoCLD and construct an effective prognostic nomogram model for older patients with AoCLD. METHODS data from 3,970 patients included in the CATCH-LIFE study were used, including 2,600 and 1,370 patients in the training and validation sets, respectively. Multivariate Cox regression analyses were performed to identify predictive risk factors in older individuals, and an easy-to-use nomogram was established. Performance was assessed using area under the curve, calibration plots and decision curve analysis (DCA). RESULTS of the 3,949 patients with AoCLD, 809 were older with a higher proportion of autoimmune-related abnormalities, hepatitis C viral infection and schistosomiasis. In the older patient group, the incidence of cirrhosis, hepatic encephalopathy (HE), infection, ascites and gastrointestinal bleeding; neutrophil-to-lymphocyte ratio (NLR), aspartate-to-alanine transaminase ratio (AST/ALT), creatinine and blood urea nitrogen levels were higher, whereas incidence of acute-on-chronic liver failure, white blood cell, platelet and haemoglobin levels; albumin, total bilirubin (TB), AST and ALT levels; international normalised ratio (INR), estimated glomerular filtration rate and blood potassium levels were lower than in the younger group. The final nomogram was developed based on the multivariate Cox analysis in training cohort using six risk factors: ascites, HE grades, NLR, TB, INR and AST/ALT. Liver transplantation-free mortality predictions were comparable between the training and validation sets. DCA showed higher net benefit for the nomograph than the treat-all or treat-none strategies, with wider threshold probabilities ranges. CONCLUSIONS our analysis will assist clinical predictions and prognoses in older patients with AoCLD.
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Affiliation(s)
| | | | | | | | | | | | - Zhongji Meng
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China,Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yubao Zheng
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China,Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanhang Gao
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China,Department of Hepatology, The First Hospital of Jilin University, Changchun, China
| | - Zhiping Qian
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China,Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China
| | - Feng Liu
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China,Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China
| | - Xiaobo Lu
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China,Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Yu Shi
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia Shang
- Chinese Chronic Liver Failure (CLIF) Consortium, Shanghai, China,Department of Infectious Diseases, Henan Provincial People’s Hospital, Zhengzhou, China
| | - Yan Huang
- Address correspondence to: Ruochan Chen, Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China. ; Yan Huang, Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China.
| | - Ruochan Chen
- Address correspondence to: Ruochan Chen, Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China. ; Yan Huang, Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China.
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7
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Wang Y, Dong F, Sun S, Wang X, Zheng X, Huang Y, Li B, Gao Y, Qian Z, Liu F, Lu X, Liu J, Ren H, Zheng Y, Yan H, Deng G, Qiao L, Zhang Y, Gu W, Xiang X, Zhou Y, Xu B, Hou Y, Zhang Q, Xiong Y, Zou C, Chen J, Huang Z, Jiang X, Qi T, Luo S, Chen Y, Gao N, Liu C, Yuan W, Mei X, Li J, Li T, Zheng R, Zhou X, Zhang W, Li H, Meng Z. Increased INR Values Predict Accelerating Deterioration and High Short-Term Mortality Among Patients Hospitalized With Cirrhosis or Advanced Fibrosis. Front Med (Lausanne) 2021; 8:762291. [PMID: 34869468 PMCID: PMC8637055 DOI: 10.3389/fmed.2021.762291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background and Objective: An increase in the international normalized ratio (INR) is associated with increased mortality in patients with cirrhosis and other chronic liver diseases, while little is known about the quantitative relationship. This study aimed to investigate the quantitative relationship between the INR and short-term prognosis among patients hospitalized with cirrhosis or advanced fibrosis and to evaluate the role of the INR as a risk factor for short-term liver transplant (LT)-free mortality in these patients. Patients and Methods: This study prospectively analyzed multicenter cohorts established by the Chinese Acute-on-Chronic Liver Failure (CATCH-LIFE) study. Cox regression was used to describe the relationship between the INR and independent risk factors for short-term LT-free mortality. Forest plots were used in the subgroup analysis. Generalized additive models (GAMs) and splines were used to illustrate the quantitative curve relationship between the INR and the outcome and inflection point on the curve. Results: A total of 2,567 patients with cirrhosis and 924 patients with advanced fibrosis were included in the study. The 90-day LT-free mortality of patients with cirrhosis and advanced fibrosis was 16.7% (428/2,567) and 7.5% (69/924), respectively. In the multivariable Cox regression analysis, the increase in the INR was independently associated with the risk of 90-day LT-free mortality both in patients with cirrhosis (HR, 1.06; 95% CI, 1.04–1.07, p < 0.001) and in patients with advanced fibrosis (HR, 1.09; 95% CI, 1.06–1.12, p < 0.001). An INR of 1.6/1.7 was found to be the starting point of coagulation dysfunction with a rapid increase in mortality in patients with cirrhosis or in patients with advanced fibrosis, respectively. A 28-day LT-free mortality of 15% was associated with an INR value of 2.1 in both cirrhosis and advanced fibrosis patients. Conclusions: This study was the first to quantitatively describe the relationship between the INR and short-term LT-free mortality in patients with cirrhosis or advanced fibrosis. The starting points of INR indicating the rapid increase in mortality and the unified cutoff value of coagulation failure in cirrhosis and advanced fibrosis, will help clinicians accurately recognize early disease deterioration.
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Affiliation(s)
- Ying Wang
- Department of Infectious Disease, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China.,Chinese Chronic Liver Failure Consortium, China
| | - Fuchen Dong
- Chinese Chronic Liver Failure Consortium, China.,Department of Gastroenterology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shuning Sun
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xianbo Wang
- Chinese Chronic Liver Failure Consortium, China.,Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xin Zheng
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases, Tongji Medical College, Institute of Infection and Immunology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Huang
- Chinese Chronic Liver Failure Consortium, China.,Hunan Key Laboratory of Viral Hepatitis, Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Beiling Li
- Chinese Chronic Liver Failure Consortium, China.,Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanhang Gao
- Chinese Chronic Liver Failure Consortium, China.,Department of Hepatology, The First Hospital of Jilin University, Jilin, China
| | - Zhiping Qian
- Chinese Chronic Liver Failure Consortium, China.,Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China
| | - Feng Liu
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China
| | - Xiaobo Lu
- Chinese Chronic Liver Failure Consortium, China.,Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Junping Liu
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases, Henan Provincial People's Hospital, Henan, China
| | - Haotang Ren
- Chinese Chronic Liver Failure Consortium, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yubao Zheng
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huadong Yan
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases, Hwamei Hospital, Ningbo No. 2 Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Guohong Deng
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liang Qiao
- Chinese Chronic Liver Failure Consortium, China.,Department of Gastroenterology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhang
- Chinese Chronic Liver Failure Consortium, China.,Department of Gastroenterology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wenyi Gu
- Chinese Chronic Liver Failure Consortium, China.,Department of Gastroenterology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaomei Xiang
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yi Zhou
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Baoyan Xu
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yixin Hou
- Chinese Chronic Liver Failure Consortium, China.,Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qun Zhang
- Chinese Chronic Liver Failure Consortium, China.,Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yan Xiong
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases, Tongji Medical College, Institute of Infection and Immunology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Congcong Zou
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases, Tongji Medical College, Institute of Infection and Immunology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Chen
- Chinese Chronic Liver Failure Consortium, China.,Hunan Key Laboratory of Viral Hepatitis, Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Zebing Huang
- Chinese Chronic Liver Failure Consortium, China.,Hunan Key Laboratory of Viral Hepatitis, Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Xiuhua Jiang
- Chinese Chronic Liver Failure Consortium, China.,Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Tingting Qi
- Chinese Chronic Liver Failure Consortium, China.,Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sen Luo
- Department of Infectious Disease, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China.,Chinese Chronic Liver Failure Consortium, China
| | - Yuanyuan Chen
- Department of Infectious Disease, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China.,Chinese Chronic Liver Failure Consortium, China
| | - Na Gao
- Chinese Chronic Liver Failure Consortium, China.,Department of Hepatology, The First Hospital of Jilin University, Jilin, China
| | - Chunyan Liu
- Chinese Chronic Liver Failure Consortium, China.,Department of Hepatology, The First Hospital of Jilin University, Jilin, China
| | - Wei Yuan
- Chinese Chronic Liver Failure Consortium, China.,Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China
| | - Xue Mei
- Chinese Chronic Liver Failure Consortium, China.,Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China
| | - Jing Li
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China
| | - Tao Li
- Chinese Chronic Liver Failure Consortium, China.,Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China
| | - Rongjiong Zheng
- Chinese Chronic Liver Failure Consortium, China.,Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Xinyi Zhou
- Chinese Chronic Liver Failure Consortium, China.,Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Weituo Zhang
- Chinese Chronic Liver Failure Consortium, China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hai Li
- Chinese Chronic Liver Failure Consortium, China.,Department of Gastroenterology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhongji Meng
- Department of Infectious Disease, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China.,Chinese Chronic Liver Failure Consortium, China
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