Prediction Of Prognosis To Lamivudine In Patients With Spontaneous Reactivation Of Hepatitis B Virus-Related Acute-On-Chronic Liver Failure:Using Virologic Response At Week 4

Background/aims:Current results had demonstrated lamivudine (LAM) contributed to improve liver function and short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (ACLF) due to hepatitis B virus reactivation, but data concerning the outcome of long-term prognosis are limited. Our objective was to explore the prediction value of early viral response for prognosis and LAM resistance in ACLF patients with lamivudine treatment within 96 weeks.Methods:One hundred and forty patients presenting as ACLF were enrolled,76 patients were treated with LAM and supportive treatment (LAM group) and 64 patients only received supportive treatment (non-NAs group). All the patients were followed up until death or 96 weeks.The main endpoint was cumulative survival at 96-week, as well as the relationship between the virologic response at weeks 4 or 12 and prognosis and resistance at 96 weeks.Results:At 96 weeks, the cumulative survival was higher in the LAM group than that in the non-NA group (43/76(56.58%) vs 9/64 (14.06%), respectively, p=0.000). The survival rate of patients achieved complete viral response (CVR) at week 4 was higher than that of those with partial virologic response (PVR) during the 96-week follow-up (27/29 [93.10%] vs 16/45 [35.56%], p=0.000). In CVR patients, there was a significant improvement in model for end-stage liver failure (MELD) scores compared to PVR. Logistic recurrence indicated that both 4-week CVR and MELD scores were an independent predictor of the 96-week survival. Twelve patients developed LAM resistance (22.22%);all of them came from the PVR at 4 weeks.Conclusions:LAM contributed to significantly improve the long-term survival rate, and 4 weeks CVR predict the long term clinical outcome and LAM-resistant in patients with HBV-related ACLF.