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Silberhumer GR, Györi G, Brugger J, Baumann L, Zehetmayer S, Soliman T, Berlakovich G. MELD-Na Alterations on the Liver Transplant Waiting List and Their Impact on Listing Outcome. J Clin Med 2023; 12:jcm12113763. [PMID: 37297957 DOI: 10.3390/jcm12113763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/19/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Dynamic MELD deterioration (Delta MELD) during waiting time was shown to have significant impact on post-transplant survival. The aim of this study was to analyze the impact of MELD-Na score alterations on waiting list outcomes in liver transplant candidates. METHOD 36,806 patients listed at UNOS for liver transplantation in 2011-2015 were analyzed according to their delisting reasons. Several different MELD-Na alterations during waiting time were analyzed (e.g., maximal change, last change before delisting/transplantation). Outcome estimates were calculated according to MELD-Na scores at listing and Delta MELD. RESULTS Patients who died while on the waiting list showed a significantly higher deterioration in MELD-Na during the waiting time (6.8 ± 8.4 points) than stable patients who remained actively listed (-0.1 ± 5.2 points; p < 0.01). Patients who were considered too healthy for transplantation improved by more than 3 points on average during the waiting time. The mean peak MELD-Na alteration during the waiting time was 10.0 ± 7.6 for patients who died on the waiting list, compared to 6.6 ± 6.1 in the group of patients who finally underwent transplantation. CONCLUSIONS Deterioration of MELD-Na during waiting time and maximal MELD-Na deterioration have a significant negative impact on the liver transplant waiting list outcome.
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Affiliation(s)
- Gerd R Silberhumer
- Department of Transplant Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Györi
- Department of Transplant Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Jonas Brugger
- Department of CeMSIIS, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria
| | - Lukas Baumann
- Department of CeMSIIS, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria
| | - Sonja Zehetmayer
- Department of CeMSIIS, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Soliman
- Department of Transplant Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Gabriela Berlakovich
- Department of Transplant Surgery, Medical University of Vienna, 1090 Vienna, Austria
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Gan D, Zeng Y, Zhang K, He Y, Wan J, Zhang X, Zhang Z, Zhu L, Long T, Xie N, Zou B, Zhang X, Xiong Y, Feng G, Luo D, Xiong M. Development of a novel prognostic assessment model for hepatitis B virus-related acute-on-chronic liver failure based on reexamination results. Medicine (Baltimore) 2023; 102:e33252. [PMID: 36930107 PMCID: PMC10019111 DOI: 10.1097/md.0000000000033252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
Acute-on-chronic liver failure (ACLF) is a common clinical emergency and critical illness with rapid progression and poor prognosis. This study aims to establish a more efficient system for the prognostic assessment of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF), which will provide a guiding scheme for subsequent treatment and improve the survival rate of patients. Data on 623 patients with HBV-ACLF were recorded. Univariate and multivariate analyses were performed to determine the discriminative abilities of the novel prognostic assessment model in predicting 90-day mortality. The area under the receiver operating characteristic curve was used to evaluate the accuracy of the models. Patients were divided into high- and low-scoring groups based on the best critical values, and survival rates were analyzed using Kaplan-Meier survival analysis and compared by applying log-rank tests. The area under the curve of the new scoring system established using the results of the first reexamination, the results of the first examination, the mean daily change in these results (MDCR) and the results of other first examinations were 0.911 (95% confidence interval [CI]: 0.889, 0.933), 0.893 (95% CI: 0.868, 0.917), and 0.895 (95% CI: 0.871, 0.919), respectively. The final prognostic scoring system established using the results of the first reexamination was chosen as a novel prognostic assessment model, and patients with lower scores (first reexamination results [FRER] score ≤ 3.65) had longer survival times (P < .001). The prognostic scoring system established using the FRER combined with other examination results can better assess the prognosis of HBV-ACLF at 90 days.
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Affiliation(s)
- Dakai Gan
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
| | - Yuyu Zeng
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
- Third Clinical Medical College Affiliated to Nanchang University, Nanchang City, China
| | - Kaige Zhang
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
- Third Clinical Medical College Affiliated to Nanchang University, Nanchang City, China
| | - Yang He
- School of Medicine, Nanchang University, Nanchang City, China
| | - Jiao Wan
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
- Third Clinical Medical College Affiliated to Nanchang University, Nanchang City, China
| | - Xiaoqing Zhang
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
| | - Zhen Zhang
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
| | - Longchuan Zhu
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
| | - Tao Long
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
| | - Nengwen Xie
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
| | - Bo Zou
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
| | - Xuezhen Zhang
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
| | - Yunfeng Xiong
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
| | - Guoliang Feng
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
| | - Daya Luo
- School of Medicine, Nanchang University, Nanchang City, China
| | - Molong Xiong
- Infectious Diseases Hospital Affiliated to Nanchang University, Nanchang City, China
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Xu W, Li B, Yang Z, Li J, Liu F, Liu Y. Rethinking Liver Fibrosis Staging in Patients with Hepatocellular Carcinoma: New Insights from a Large Two-Center Cohort Study. J Hepatocell Carcinoma 2022; 9:751-781. [PMID: 35983561 PMCID: PMC9380840 DOI: 10.2147/jhc.s372577] [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: 04/27/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) is a prevalent and aggressive malignancy closely related to background chronic liver disease. This study aimed to explore predictive factors associated with background liver fibrosis burden in patients with HCC and sought to construct a practical predictive model for clinical use. Methods This large two-center retrospective cohort study evaluated data from Chinese medical centers. Uni- and multivariate ordinal logistic regression analyses were performed to identify variables associated with liver fibrosis stages. Predictive models based on variables identified by multivariate analysis were established in the Derivation Cohort and subjected to internal and external validation. Model performance was evaluated for discriminative and calibration abilities. Results Multivariate ordinal logistic regression analysis identified liver fibrosis severity score (LFSS), portal hypertension (PH) severity, plateletcrit (PCT) and model for end-stage liver disease-sodium (MELD-Na) as independent predictors of liver fibrosis stage in HCC patients. Nomograms that integrated these factors disclosed that the area under receiver operating characteristic curves (AUROCs) to predict S1 in the Derivation and External Validation cohorts were 0.850 and 0.919, respectively. Internal validation disclosed C-indexes of 0.823 and 0.833 in the Derivation and External Validation cohorts, respectively, indicating that the nomogram had good and excellent performance for distinguishing between S1 and non-S1 patients. Nomogram performance in the Derivation and External Validation cohorts, respectively, was fair and good to predict stage S2 (AUROCs 0.726, 0.806; C-indexes 0.713, 0.791); poor for S3 (AUROCs 0.648, 0.698; C-indexes 0.616, 0.666); good for S4 (AUROCs 0.812, 0.824; C-indexes 0.804, 0.792); and good for S3+S4 (AUROCs 0.806, 0.840; C-indexes 0.795, 0.811). Conclusion We propose new predictive models for the staging of background liver fibrosis in patients with HCC that can be implemented into clinical practice as important complements to hepatic imaging to inform HCC management strategy.
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Affiliation(s)
- Wei Xu
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
| | - Bolun Li
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
| | - Zhanwei Yang
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
| | - Jingdong Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Fei Liu
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
| | - Yu Liu
- Department of Pathology, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
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Integrated model for end-stage liver disease maybe superior to some other model for end-stage liver disease-based systems in addition to Child-Turcotte-Pugh and albumin-bilirubin scores in patients with hepatitis B virus-related liver cirrhosis and spontaneous bacterial peritonitis. Eur J Gastroenterol Hepatol 2019; 31:1256-1263. [PMID: 31498284 DOI: 10.1097/meg.0000000000001481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES For mortality prediction of spontaneous bacterial peritonitis (SBP) in patients with cirrhosis, no direct comparisons have been made among the eight models, Child-Turcotte-Pugh (CTP) score, model for end-stage liver disease (MELD), MELD-Na, integrated MELD (iMELD) score, MELD to sodium (MESO) index, modification of the MELD scoring system (Refit MELD), Refit MELD-Na and Albumin-Bilirubin (ALBI) score. MATERIALS AND METHODS Between January 2005 and July 2017, 314 patients who met the criteria for liver cirrhosis with the first episode of SBP were enrolled in this retrospective study. Clinical and laboratory data were obtained at diagnosis. Patients were followed up until February 2018 or death. RESULTS Patients were predominantly middle-aged male. Hepatitis B virus (HBV) infection accounted for the majority of the etiologies (41.7%) with 33.6% of the patients received antivirals. The in-hospital mortality rate was 39.8%. The cumulative 3-month and 6-month mortality rates were 51.6 and 60.2%, respectively. For patients with HBV related, not hepatitis C virus or alcohol related, liver cirrhosis, iMELD had the highest area under receiver operating characteristic curve (AUC) and was significantly superior to MELD, MESO, and Refit MELD in addition to CTP and ALBI scores in predicting 3-month and 6-month mortality. CONCLUSION For patients with HBV-related liver cirrhosis and SBP, iMELD had the highest AUC among these eight models and was significantly superior to MELD, MESO, and Refit MELD in addition to CTP and ALBI scores in predicting 3-month and 6-month mortalities.
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Fan XP, Dou CY, Fan YC, Cao CJ, Zhao ZH, Wang K. Methylation status of the estrogen receptor 1 promoter predicts poor prognosis of acute-on-chronic hepatitis B liver failure. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 109:818-827. [PMID: 29082740 DOI: 10.17235/reed.2017.4426/2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute-on-chronic hepatitis B liver failure (ACHBLF) is an acute deteriorating liver disease and rapidly progresses to multiple organ failure. There is currently no adequate accurate predictive models of ACHBLF prognosis. AIMS To identify the methylation frequency of the estrogen receptor 1 (ESR1) promoter in ACHBLF and analyze the associated prognostic significance. METHODS Methylation-specific PCR (MSP) was used to determine the methylation frequency of the ESR1 promoter in peripheral blood mononuclear cells from a training and validation cohort of patients. The training cohort included 113 patients with ACHBLF, 73 with chronic hepatitis B (CHB) and 40 healthy controls (HCs). The validation cohort consisted of 37 patients with ACHBLF. Another 18 patients with pre-ACHBLF who progressed to ACHBLF were used to dynamically evaluate ESR1 promoter methylation changes associated with a severe clinical condition. RESULTS Death from ACHBLF was associated with hyperbilirubinemia, a higher score in the model for end-stage liver disease (MELD), a higher incidence of hepatic encephalopathy (HE) and an increased frequency of ESR1 promoter methylation during the 28 day follow-up. HE, MELD score and ESR1 promoter methylation were the independent risk factors associated with 28-day mortality from ACHBLF. The frequency of ESR1 promoter methylation was significantly higher than in patients with CHB and HCs. Albumin and the MELD score were significantly associated with ESR1 promoter methylation. Moreover, ESR1 promoter methylation frequency increased with ACHBLF progression. More importantly, ESR1 promoter methylation was an independent risk factor and had a high value to predict 28-day mortality from ACHBLF. CONCLUSIONS Abnormal ESR1 methylation could be a prognostic biomarker for ACHBLF.
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Affiliation(s)
- Xiao-Peng Fan
- Department of Hepatology, Qilu Hospital of Shandong University
| | - Cheng-Yun Dou
- Department of Hepatology, Qilu Hospital of Shandong University
| | - Yu-Chen Fan
- Department of Hepatology, Qilu Hospital of Shandong University;Hepatology Institute of Shandong University
| | - Chuang-Jie Cao
- Department of Pathology, the first affiliated hospital of Sun Yat-san University
| | - Ze-Hua Zhao
- Department of Hepatology, Qilu Hospital of Shandong University
| | - Kai Wang
- Department of Hepatology, Qilu Hospital of Shandong University, China
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Huang GQ, Xie YY, Zhu PW, Wang XD, Lin Z, Wang Y, Ye JP, Wang YM, Chen YX, Jin XZ, Van Poucke S, Chen YP, Zheng MH. Stratified alpha-fetoprotein pattern accurately predicts mortality in patients with acute-on-chronic hepatitis B liver failure. Expert Rev Gastroenterol Hepatol 2018; 12:295-302. [PMID: 29300103 DOI: 10.1080/17474124.2018.1424540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Alpha-fetoprotein (AFP) has been shown to predict the prognosis of liver disease in several studies. This study aimed to evaluate the prognostic value of stratified AFP in patients with acute-on-chronic hepatitis B liver failure (ACHBLF). METHODS A total of 192 patients were included and AFP were categorized into quartiles. The prognostic value was determined for overall survival (OS) and assessed by Kaplan-Meier analysis. Univariate and multivariate Cox proportional hazard regression analyses studied the association of all independent parameters with disease prognosis. RESULTS The optimal cut-off points of AFP were: (Q1) 252.3-4800.0 ng/ml, (Q2) 76.0-252.2 ng/ml, (Q3) 18.6-75.9 ng/ml, and (Q4) 0.7-18.5 ng/ml. Based on the Kaplan-Meier analysis of the OS, each AFP quartile revealed a progressively worse OS and apparent separation (log-rank P = 0.006). The second-highest quartiles of AFP (Q2) always demonstrated an extremely favorable short-term survival. Combining the lowest AFP quartiles with a serum sodium < 131mmol/L or an INR ≥ 3.3 showed a poor outcome (90-days survival of 25.0% and 11.9% respectively). CONCLUSIONS Stratified AFP could strengthen the predictive power for short-term survival of patients with ACHBLF. Combining AFP quartiles with low serum sodium and high INR may better predict poor outcome in ACHBLF patients.
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Affiliation(s)
- Gui-Qian Huang
- a Department of Hepatology, Liver Research Center , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.,b Department of Neurology , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Yao-Yao Xie
- c Department of Clinical Laboratory , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Pei-Wu Zhu
- c Department of Clinical Laboratory , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Xiao-Dong Wang
- a Department of Hepatology, Liver Research Center , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.,d Institute of Hepatology , Wenzhou Medical University , Wenzhou , China
| | - Zhuo Lin
- a Department of Hepatology, Liver Research Center , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.,d Institute of Hepatology , Wenzhou Medical University , Wenzhou , China
| | - Yan Wang
- a Department of Hepatology, Liver Research Center , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Jiang-Pin Ye
- a Department of Hepatology, Liver Research Center , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Yu-Min Wang
- c Department of Clinical Laboratory , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Ying-Xiao Chen
- a Department of Hepatology, Liver Research Center , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Xiao-Zhi Jin
- a Department of Hepatology, Liver Research Center , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China
| | - Sven Van Poucke
- e Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy , Ziekenhuis Oost-Limburg , Genk , Belgium
| | - Yong-Ping Chen
- a Department of Hepatology, Liver Research Center , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.,d Institute of Hepatology , Wenzhou Medical University , Wenzhou , China
| | - Ming-Hua Zheng
- a Department of Hepatology, Liver Research Center , The First Affiliated Hospital of Wenzhou Medical University , Wenzhou , China.,d Institute of Hepatology , Wenzhou Medical University , Wenzhou , China
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A novel dynamic model for predicting outcome in patients with hepatitis B virus related acute-on-chronic liver failure. Oncotarget 2017; 8:108970-108980. [PMID: 29312583 PMCID: PMC5752496 DOI: 10.18632/oncotarget.22447] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022] Open
Abstract
Aim It is challenging to predict the outcome of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) through existing prognostic models. Our aim was to establish a novel dynamic model to improve the predictive efficiency of 30-day mortality in HBV-ACLF patients. Methods 305 patients who were diagnosed as HBV-ACLF (derivation cohort, n=211; validation cohort, n=94) were included in this study. The HBV-ACLF dynamic (HBV-ACLFD) model was constructed based on the daily levels of predictive variables in 7 days after diagnosis combined with baseline risk factors by multivariate logistic regression analysis. The HBV-ACLFD model was compared with the Child-Turcotte-Pugh (CTP) score, end-stage liver disease (MELD) score, and MELD within corporation of serum sodium (MELD-Na) score by the area under the receiver-operating characteristic curves (AUROC). Results The HBV-ACLFD model demonstrated excellent discrimination with AUROC of 0.848 in the derivation cohort and of 0.813 in the validation cohort (p=0.620). The performance of the HBV-ACLFD model appeared to be superior to MELD score, MELD-Na score and CTP score (P<0.0001). Conclusion The HBV-ACLFD model can accurately predict 30-day mortality in patients with HBV-ACLF, which is helpful to select appropriate clinical procedures, so as to relieve the social and economic burden.
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Zheng YX, Zhong X, Li YJ, Fan XG. Performance of scoring systems to predict mortality of patients with acute-on-chronic liver failure: A systematic review and meta-analysis. J Gastroenterol Hepatol 2017; 32:1668-1678. [PMID: 28303605 DOI: 10.1111/jgh.13786] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/03/2017] [Accepted: 03/13/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Acute-on-chronic liver failure (ACLF) has characteristic feature of multisystem organ failure, rapid progression, and low early transplant-free survival. We performed a meta-analysis to determine the accuracy of five scoring systems in predicting mortality of ACLF patients. METHODS A systematic database search was performed, and retrieved articles were graded according to methodological quality. Collated data was meta-analyzed by hierarchical summarized receiver operating characteristic model and bivariate model to evaluate the diagnostic accuracy of scoring systems. RESULTS Of 4223 studies identified, 26 studies involving 4732 ACLF patients were included. The model of end-stage liver disease (MELD) score was found to have largest the area under summarized receiver operating characteristic (AUROC) (0.82) compared with other estimated scoring systems, especially for 3-month mortality. MELD serum sodium (MELD-Na) score showed homologous high accuracy, with the AUROC was 0.81. However, meta-analyses of 16 studies showed that Child-Pugh-Turcotte score had least AUROC (0.71). Sequential organ failure assessment (SOFA) score presented moderately lower diagnostic accuracy, with AUROC being 0.73. Moreover, chronic liver failure-SOFA score presented excellent accuracy of prognostication with highest diagnostic odds ratios. CONCLUSION This review demonstrated that MELD had moderate diagnostic accuracy to predict mortality of ACLF patients. Considering the expectative diagnostic value, chronic liver failure-SOFA could be regarded as a promising replacement of MELD. To improve the predictive power of scoring systems, multicenter prospective studies of large sample sizes with long-term follow-up are needed.
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Affiliation(s)
- Yi-Xiang Zheng
- Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Zhong
- Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, China
| | - Ya-Jun Li
- Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, China
| | - Xue-Gong Fan
- Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, China
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Zhao J, Fan YC, Liu XY, Zhao ZH, Li F, Wang K. Hypermethylation of the galectin-3 promoter is associated with poor prognosis of acute-on-chronic hepatitis B liver failure. Dig Liver Dis 2017; 49:664-671. [PMID: 28185839 DOI: 10.1016/j.dld.2017.01.158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 01/12/2017] [Accepted: 01/13/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS The possible role of galectin-3 in acute-on-chronic hepatitis B liver failure (ACHBLF) remains unknown. This study aimed to determine the methylation status of the galectin-3 promoter in patients with ACHBLF and analyze its prognostic value. METHODS The methylation status of the galectin-3 promoter in patients with ACHBLF, chronic hepatitis B (CHB) and healthy controls (HCs) was determined by methylation-specific polymerase chain reaction (MSP). The galectin-3 mRNA level in peripheral blood mononuclear cells (PBMCs) was detected using real-time polymerase chain reaction (RT-PCR). RESULTS The methylation frequency of the galectin-3 promoter was significantly higher while galectin-3 mRNA was lower in ACHBLF than in CHB and HCs. Galectin-3 promoter methylation was negatively correlated with the mRNA level in ACHBLF. In addition, ACHBLF patients carrying the methylated promoter showed shorter survival time, higher 3-month mortality, and higher model for end-stage liver disease (MELD) score when compared to ACHBLF patients carrying the unmethylated promoter. Moreover, promoter methylation was a better predictor of 3-week mortality than the MELD score in ACHBLF patients. CONCLUSION Our results suggest that hypermethylation of the galectin-3 promoter might be an early biomarker for predicting disease severity and prognosis in patients with ACHBLF.
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Affiliation(s)
- Jing Zhao
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, China
| | - Yu-Chen Fan
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, China; Institute of Hepatology, Shandong University, Jinan, China
| | - Xin-Yuan Liu
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, China
| | - Ze-Hua Zhao
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, China
| | - Feng Li
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, China
| | - Kai Wang
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, China; Institute of Hepatology, Shandong University, Jinan, China.
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Shen Y, Wang X, Zhang S, Qin G, Liu Y, Lu Y, Liang F, Zhuang X. A comprehensive validation of HBV-related acute-on-chronic liver failure models to assist decision-making in targeted therapeutics. Sci Rep 2016; 6:33389. [PMID: 27633520 PMCID: PMC5025883 DOI: 10.1038/srep33389] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/25/2016] [Indexed: 12/13/2022] Open
Abstract
This research utilized an external longitudinal dataset of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) to compare and validate various predictive models that support the current recommendations to select the most effective predictive risk models to estimate short- and long-term mortality and facilitate decision-making about preferable therapeutics for HBV-ACLF patients. Twelve ACLF prognostic models were developed after a systematic literature search using the longitudinal data of 232 HBV-ACLF patients on the waiting list for liver transplantation (LT). Four statistical measures, the constant (A) and slope (B) of the fitted line, the area under the curve (C) and the net benefit (D), were calculated to assess and compare the calibration, discrimination and clinical usefulness of the 12 predictive models. According to the model calibration and discrimination, the logistic regression models (LRM2) and the United Kingdom model of end-stage liver disease(UKELD) were selected as the best predictive models for both 3-month and 5-year outcomes. The decision curve summarizes the benefits of intervention relative to the costs of unnecessary treatment. After the comprehensive validation and comparison of the currently used models, LRM2 was confirmed as a markedly effective prognostic model for LT-free HBV-ACLF patients for assisting targeted and standardized therapeutic decisions.
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Affiliation(s)
- Yi Shen
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, China
| | - Xulin Wang
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, China
| | - Sheng Zhang
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, China
| | - Gang Qin
- Center for Liver Diseases, Nantong Third People's Hospital, Nantong University, Nantong, China
| | - Yanmei Liu
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, China
| | - Yihua Lu
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, China
| | - Feng Liang
- Qidong Third People's Hospital, Nantong, China
| | - Xun Zhuang
- Department of Epidemiology and Medical Statistics, Nantong University, Nantong, China
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11
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Zhang Q, Guo X, Zhao S, Pang X, Wang Y, Zhang Y, Chi B. Prognostic performance of clinical indices and model scorings for acute-on-chronic liver failure: A study of 164 patients. Exp Ther Med 2016; 11:1348-1354. [PMID: 27073448 DOI: 10.3892/etm.2016.3037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 12/21/2015] [Indexed: 12/14/2022] Open
Abstract
The present study aimed to analyze the prognostic factors of acute-on-chronic liver failure (ACLF), with the perspective of an improved selection of optimal therapeutic schemes. A retrospective analysis was used to study 164 patients with ACLF hospitalized between 2010 and 2014 in a single center. Patients were divided into favorable and unfavorable groups, according to the treatment outcomes. General characteristics and clinical manifestations were analyzed to determine whether they would affect the prognosis of the patients with ACLF, with a particular focus on the scoring systems Child-Pugh, model for end-stage liver disease (MELD), MELD with incorporation of sodium (MELD-Na), MELD and serum sodium ratio (MESO) and integrated MELD (iMELD). Hepatitis B virus infection was the predominant cause of ACLF, accounting for 88 cases (53.7%). Age, prothrombin time, thrombin time, international normalized ratio (INR), prothrombin activity, serum sodium, albumin, total bilirubin, serum creatinine, platelets, fasting blood sugar, infections, hepatic encephalopathy, hepatorenal syndrome (HRS), and electrolyte disorder were revealed to be associated with prognosis. Age, serum sodium, INR, HRS, and infection were independent prognostic risk factors, as determined by multivariate analysis. Child-Pugh, MELD, MELD-Na, MESO and iMELD scoring systems all demonstrated adequate predictive values, with MELD-Na as the most effective scoring system. In conclusion, age, hyponatremia, INR, HRS and bacterial or fungal infections were reported to be independent prognostic risk factors for ACLF. Among the various liver function scoring systems, MELD-Na was the most accurate in predicting the prognosis of ACLF.
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Affiliation(s)
- Qianqian Zhang
- Department of Hepatobiliary and Pancreatic Diseases, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xiaolin Guo
- Department of Hepatobiliary and Pancreatic Diseases, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shixing Zhao
- Department of Intensive Care Unit, Affiliated Hospital of Jining Medical University, Jining, Shandong 272000, P.R. China
| | - Xiaoli Pang
- Department of Hepatobiliary and Pancreatic Diseases, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yang Wang
- Department of Hepatobiliary and Pancreatic Diseases, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yujiao Zhang
- Department of Infectious Diseases, China-Japan Friendship Hospital, Beijing 100029, P.R. China
| | - Baorong Chi
- Department of Hepatobiliary and Pancreatic Diseases, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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