Study On The Prognosis And Intervention Of Integrated Traditional Chinese Medicine And Western Medicine For Hepatitis B Virus Associated Acute-on-chronic Liver Failure

Aim:To identify the beneficial patients with hepatitis B virus-associated acute-on-chronic liver(HBV-ACLF)treated by the integrated Traditional Chinese Medicine(TCM)and western medicine(WM),and identify the independent prognostic factors,then establish a nomogram to predict the outcome and in aid of clinical decision-making for HBV-ACLF patients.Method:We performed an analysis of the "Study on HBV-ACLF treated with integrated Traditional Chinese Medicine and western medicine".According to the actual therapy,HBV-ACLF patients were divided into the TCM group and the WM group.Compared the mortality rate of patients in the two groups,screened the independent prognostic factors,established a nomogram to predict the outcome of HBV-ACLF patients,detected the levels of serum IL-6 of HBV-ACLF patients by ELISA,as well as IL-2,IL-4,IL-5,IL-10,INF-gamma and TNF-alpha,and compared the serum cytokines levels of patients with different injuries or outcomes,and compared the dynamic changes of cytokines for patients in TCM group or WM group.Results:1.The mortality rates of patients in TCM group(11.6%,17.9%,20.6%,24.5%,27%)were significantly lower than those in the WM group(19.1%,25.5%,27.3%,31.4%,32%)at 4 weeks,8 weeks,12 weeks,24 weeks and 48 weeks(P<0.05).The relative mortality risks of patients in TCM group,compared with those in WM group were respectively 0.57,0.63,0.72,0.65,0.73(P<0.05).2.Compared with HBV-ACLF patients in WM group,the relative mortality risks of those in the TCM group were decreased among young patients(age less than or equal to 44)(HR=0.42,95%CI:0.27-0.66),patients with hepatic encephalopathy(HE)(HR=0.29,95%CI:0.15-0.58)and patients at late stage(HR=0.44,95%CI:0.30-0.67).3.Old age(HR=1.02,95%CI:1.01-1.04),high level of total bilirubin(TBIL)(HR=1.04,95%CI:1.02-1.07),high level of international standardized ratio(INR)(HR?2.58,95%CI:1.98-3.37),the presence of HE(stage ?/?:HR=2.20,95%CI:1.25-3.87;stage ?/?:HR=23.67,95%CI:7.74-72.37),or hepatorenal syndrome(HRS)(HR=3.64,95%CI:1.69-7.82),or hyponatremia(HR=1.86,95%CI:1.22-2.84),and low level of platelet count(>20/<60:HR=1.42,95%CI:1.89-2.27;>60:HR=2.42,95%CI:1.94-6.20)increased the mortality risk of HBV-ACLF patients.4.The performance of nomogram using the area under the receiver operating characteristic curves(AUROC)was better than MELD and MELD-Na scores in predicting the outcomes of HBV-ACLF patients at 28 days and 336 days(AUROC:0.87 vs 0.79/0.80,0.82 vs 0.73/0.75),and was better than MELD score(AUROC:0.86 vs 0.79,p=0.042)in predicting outcomes at 90-day,but was not different from MELD-Na score(AUROC:0.86 vs 0.82,p=0.140)at 90-day.5.The serum IL-6 level of HBV-ACLF patients in the early stage was significantly higher than those in the middle stage(P<0.001)or late stage(P<0.001).The serum IL-6 level of HBV-ACLF patients with at least two organs failure was higher than that of patients with one organ failure(P=0.014).The serum IL-6 level of HBV-ACLF patients in the high-risk group was higher than that in the low-risk group(P<0.001).The serum IL-6 level of dead patients with HBV-ACLF was higher than that of survivals(P<0.001).The HBV-ACLF patients with higher level of serum IL-6 had a more mortality risk than those with lower level(HR=1.69,95%CI:1.27-2.25,p<0.001).Conclusion:Our study proved that the integrated TCM and WM could decease the mortality rate of HBV-ACLF patients,especially in young patients(age less than or equal to 44),patients with HE,or patients at late stage.The nomogram performed well in predicting the outcome of HBV-ACLF patients.Serus IL-6 could be a potential index for judging hepatic impairment and predicting outcome of HBV-ACLF patients.