Risk Factors Associated With Progression To Acute-on-chronic Liver Failure In Patients With Chronic Hepatitis B During Hepatitis Relapse After Nucleos(t)ide Analogues Withdrawal

Objective:To study the risk factors associated with progression to acute-on-chronic liver failure(ACLF)in patients with chronic hepatitis B(CHB)during hepatitis relapse after nucleos(t)ide analogues(NAs)withdrawal.Methods:The clinical data of 55 CHB patients with hepatitis relapse after NAs withdrawal admitted to the Department of Infectious Diseases of Affiliated Hospital of Zunyi Medical University from January 2012 to December 2018 were respectively reviewed.The patients were divided into non-ACLF group(n=43)and ACLF group(n=12)according to they whether progross to ACLF within 28 days after admission,and their clinical characteristics were compared between the two groups.The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between groups.The chi-square test was used for comparison of categorical data between groups.The logistic regression analysis was performed to identify the risk factors associated with progression to ACLF after NAs withdrawal.Results:There were significant differences in age,prevalence of liver cirrhosis,time from NAs withdrawal to relapse,serum levels of HBV DNA at NAs withdrawal,model for end-stage liver disease(MELD)and model for end-stage liver disease–Na(MELD-Na)score,serum levels of HBV DNA,Na~+,cholinesterase(CHE),total bilirubin(TBIL),total bile acid(TBA),albumin(ALB),prealbumin(PA),total cholesterol(TC),high density lipoprotein(HDL),low density lipoprotein(LDL),activated partial prothrombin time(APTT),international normalized ratio(INR),prothrombin activity(PTA)and platelet(PLT)at admission between the non-ACLF group and ACLF group.The ages,prevalence of liver cirrhosis,serum levels of HBV DNA at NAs withdrawal,MELD and MELD-Na score and serum levels of HBV DNA at admission,TBIL,TBA,APTT and INR were significantly higher in patients with ACLF than those in patients without ACLF,while the time from NAs withdrawal to relapse,serum levels of Na~+,ALB,PA,TC,HDL,LDL PLT and PTA at admission were significantly lower in patients with ACLF than those in patients without ACLF.There was no significant differences in sex,type of NAs,course of the antiviral treatment between the two groups.The univariate logistic regression analysis showed that older age,liver cirrhosis,higher serum levels of HBV DNA at the time of NAs withdrawal and at admission,higher serum levels of TBIL,TBA,APTT,INR,MELD scores,lower serum levels CHE,ALB,PA,and PTA at admission are the risk factors for progression of liver failure.The multivariate logistic regression analysis showed that higher serum levels of HBV DNA at admission is the independent risk factor for progression of liver failure.Conclusion:Older age,liver cirrhosis,higher serum levels of HBV DNA at the time of NAs withdrawal and at admission,higher serum levels of TBIL,TBA,APTT,INR,MELD scores,lower serum levels CHE,ALB,PA,and PTA at admission are the risk factors associated with the progression to ACLF.Higher serum levels of HBV DNA at admission is the independent risk factor for progression of liver failure in patients with CHB during hepatitis relapse after NAs withdrawal.