Comparative analysis on the influence factors of short-term and long-term prognosis in patients with HBV-related acute-on-chronic liver failure

Objective To comparative analyze the influence factors of short-term (6 months) and long-term (10 years) prognosis in patients with HBV-related acute-on-chronic liver failure (ACLF), and to provide some reference values on clinic therapy and follow-up management. Methods The data of 524 hospitalized patients with ACLF from January 2001 to December 2009 were analyzed retrospectively. The follow-up termination time was December 2013. Patients were all given internal medical therapy, and were given antiviral therapy with nucleoside and nucleotide analogs (NAs) (yes/no) and plasma exchange in artificial liver support system (yes/no) according to the patient′s informed choice. The method of Cox regression analysis was used to analyze the short-term prognostic factors and long-term prognosis factors of ACLF. Results The short-term prognosis factors in patients with ACLF were MELD scores, ages, percentage of neutrophils, hepatic encephalopathy, whether to apply NAs or not, HBV DNA levels, times of plasma exchange in artificial liver support system, cholinesterase levels and total bilirubin levels in turn (P<0.05). The long-term prognosis factors were ages, whether to apply NAs or not, MELD scores, cholinesterase levels, concomitant infection, white blood cell counts, gender and hepatic encephalopathy in turn (P<0.05), and antiviral therapy with NAs was a time-dependent independent prognostic factor. Conclusions There are some differences between the short-term prognosis factors and the long-term prognosis factors in patients with ACLF. We should give antiviral therapy with NAs, measures to improve liver function, preventions and treatments of infection and hepatic encephalopathy and other complications from early-stage to long-term follow-up managements. And in early-stage of ACLF we should also give the treatment with artificial liver support system. Key words: Hepatitis B virus; Acute-on-chronic liver failure; Prognosis; Regression analysis