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Table of Content

    31 October 2018, Volume 23 Issue 10
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    Original Articles
    Analysis of risk factors for acute kidney injury in patients with acute on chronic liver failure complicated with spontaneous bacterial peritonitis
    SU Hai-bin, LIU Xiao-yan, CHEN Jin, LI Chen, TONG Jin-jin, XU Xiang, GUAN Chong-dan, YAN Li-long, PENG Yu-hui, NING Peng, LI Hui, HU Jin-hua.
    2018, 23(10):  860-863. 
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    Objective To study the risk factors for acute kidney injury (AKI) in patients with acute on chronic liver failure (ACLF) complicated with spontaneous bacterial peritonitis (SBP). OMethods The incidence of AKI in ACLF patients complicated with SBP was retrospectively analyzed. Basic information, etiology of ACLF, laboratory indexes, co-infection and the efficacy of early anti-infection therapy were analyzed using univariate and multivariate analysis. Results The incidence of AKI was 41.4% (153/370) in ACLF patients complicated with SBP. It was observed that age, white blood cell (WBC) count, total bilirubin level, international normalized ratio and C reactive protein (CRP) level were higher in patients with AKI than those in patients without, respectively [(51.5±41.6 years old vs. 48±11.1 years old, (12.4±7.3)×109/L vs. (8.8±5.3)×109/L, 375.4±136.9 μmol/L vs. 347.8±121.2 μmol/L, 2.3±0.9 vs. 2.0±0.6, 37.1±32.8 ug/L vs. 23.0±19.2 ug/L, all P<0.05]. However, levels of mean arterial pressure, albumin, serum Na+ and the response rate of initial anti-infection therapy were lower in patients with AKI than those in patients without, respectively (86.9±13.8 mmHg vs. 90.6±9.9 mmHg, 26.6±5.6 g/L vs. 28.7±8.3 g/L, 130.3±5.4 μmol/L vs. 133.5±4.5 μmol/L, 57.0% vs. 75.7%, P<0.05). It is revealed that age, WBC count, serum Na+ level, CRP level and the efficacy of early anti-infection therapy were associated with the development of AKI in ACLF patients with SBP. Moreover, treatment failure was more often in patients with AKI (60.1% vs. 39.2%, P<0.05).Conclusion ACLF patients with SBP are predisposed to AKI. The risk factors include old age, increased WBC count, high CRP level, low serum Na+ level and ineffective initial anti-infection therapy.
    Risk factors for hepatocellular carcinoma among patients with chronic hepatitis B in the era of nucleos(t)ide analogues treatment
    JIANG Meng, LIU Ya-yun, SUN Shuang-shuang, CHEN Shang-jun, LIANG Xue-song.
    2018, 23(10):  864-867. 
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    Objective To analyze risk factors for hepatocellular carcinoma (HCC) among patients with chronic hepatitis B (CHB) in the era of continuous treatment with nucleos(t)ide analogues. OMethods In this study, questionnaire survey was used to collect the clinical data of 285 patients with CHB enrolled in Department of Infectious Diseases in 413 Military Hospital from March 2013 to September 2017. Risk factors for HCC were identified by univariate and multivariate analysis. Results Univariate analysis showed that gender, age, antiviral treatment, cirrhosis statue, serum hepatitis B virus (HBV) DNA level, and HCC family history were correlated with development of HCC among patients with CHB (P<0.05). Furthermore, multivariate logistic regression analysis showed that age older than 40 years (OR=3.318, P=0.019), no antiviral therapy (OR=2.709,P=0.002), HCC family history (OR=2.096,P=0.037), and cirrhosis were the main risk factors for HCC development. Child-Pugh C, B and A patients with cirrhosis all had significantly higher risk of HCC than those without cirrhosis (OR-C=18.453,OR-B=13.395,OR-A=6.970,P=0.000).Conclusion Age older than 40 years, cirrhosis statue, no antiviral treatment, family history of HCC are major risk factors for HCC development. Patients with risk factors should receive prompt antiviral treatment and be closely followed up.
    Prognostic value of the model for end-stage liver disease score for patients with severe chronic hepatitis B
    DING Jian-bo, LI Xiu-hui, GOU Chun-yan, WANG Xiao-jun, HAO Xin-jie, WANG Xian-bo.
    2018, 23(10):  868-869. 
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    Objective To investigate the validity of the model for end-stage liver disease (MELD) score in predicting the prognosis of patients with severe chronic hepatitis B (CHB). OMethods A total of 561 patients with severe CHB collected from January 2006 to December 2008 in 5 hospitals were divided into the survivor group and the death group. MELD score of all the cases was calculated and its predictive value for severe CHB was evaluated by t-test, logistic regression analysis and the area under the receiver operating characteristic curve (AUROC). Results The average MELD score in the death group was statistically higher than that in the survivor group (28.94±8.76 vs. 22.25±4.35, P<0.001). The mortality would be increased to 1.182 times every 1 score increased in MELD. The predictive accuracy rate of MELD score using logistic regression analysis was 68.4% (P<0.001). AUROC for prediction of the mortality in patients using MELD score was 0.759 with medium accuracy (95% confidence interval: 0.720~0.798, MELD threshold: 27).Conclusion MELD score may be useful in predicting the prognosis of patients with severe CHB, but the power is medium. Therefore, a better mathematical model should be developed to predict the prognosis of the patients with severe CHB in China.
    A preliminary analysis of clinical risk factors for severe intrahepatic cholestasis of pregnancy
    SHEN Jian-fang, ZHU Ya-ping, GU Lei-lei, ZHANG Xin-xin, KONG Xiao-fei.
    2018, 23(10):  870-872. 
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    Objective To investigate the potential risk factors for severe intrahepatic cholestasis of pregnancy (ICP).OMethods A retrospective single-center study was conducted in 79 patients with ICP. Their clinical data was analyzed, including basic information, liver injuries, impacts on delivery and neonates. According to the level of bile acid, 79 ICP patients were divided into mild (n=55) and severe groups (n=24). Results Patients in severe group were older (31.04±3.56 years old vs. 28.95±4.13 years old, P=0.034) and had earlier onset time during pregnancy (250.2±26.57 days vs. 258.2±13.27 days, P=0.079) than those in mild group. The prevalence of hepatitis B virus (HBV) infection was found to be significantly higher in those with severe ICP (33.33% vs. 14.55%, P=0.056). The cesarean rate of severe group was significantly higher than that of mild group (92% vs. 58%, P=0.006). No statistical difference was observed in the survival rate of neonates.Conclusion The older age, earlier onset time and HBV infection are associated with an increased risk of developing severe ICP.
    Efficacy of entecavir in patients with hepatitis B virus related acute-on-chronic liver failure
    DAI Jin-jin, ZHU Chuan-wu, CAI Wei, CHEN Lu.
    2018, 23(10):  873-877. 
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    Objective To evaluate the efficacy of entecavir (ETV) in patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF).OMethods Clinical data of 235 HBV-ACLF patients hospitalized in Ruijin Hospital from January 2012 to November 2017 were collected and analyzed. All patients received nucleos(t)ide analogues (NA) treatment besides internal medicine therapy, including the control group receiving lamivudine (LAM) 100 mg/d and the treatment group receiving ETV 0.5mg/d. Serum biochemistry, prothrombin time activity (PTA) and hepatitis B virus (HBV) DNA load were detected before and after NA treatment (at baseline, week 1, 2, 4 and 12). Clinical features and treatment outcomes were compared between the 2 groups. Results Baseline characteristics showed no statistical difference between ETV and LAM groups (age: 49.4 vs. 45.7 years old, alanine transaminase: 1170 vs. 1172 IU/mL, aspartate aminotransferase: 932 vs. 904 IU/mL, HBV DNA: 5.27×107 vs. 5.8×107 IU/mL, P>0.05). After NA treatment, levels of biochemical indexes and HBV DNA declined (HBV DNA: 2.96 vs. 2.95 lg copies/mL, P>0.05). For patients with MELD score > 20 or severe complications ≥ 2 at baseline, survival analysis revealed that ETV group had significantly higher survival rate than LAM group at week 1 (95.7% vs. 81.7%, P<0.05), while no statistical difference at week 4 and 12 (week 4: 69.0% vs. 65.2%, week 12: 36.6% vs. 46.4%, both P>0.05). PTA and cirrhosis statue showed no obvious effect on survival rate of the 2 groups. Furthermore, there was no significant difference in the effective rate between 2 groups at the end of treatment (33.6%/40.2%, P>0.05). Conclusion ETV is beneficial for the improvement of short-term survival rate (at week 1) in severe HBV-ACLF patients (MELD score>20 or complications ≥ 2).