Clinical application of acute-on-chronic liver failure classification recommended by World Gastroenterology Organization

Objective To explore whether the definition of acute-on-chronic liver failure (ACLF) which is recommended by World Gastroenterology Organization (WGO) is suitable for the clinical management of HBV-ACLF patients in China. Methods The clinical data of 606 HBV-ACLF patients hospitalized in the Fifth Medical Center of PLA General Hospital were retrospectively collected and divided into three groups of type A (183 cases) , type B (317 cases) and type C (106 cases) according to the ACLF classification criteria proposed by WGO. The clinical features and prognosis of three types of patients were compared. The influencing factors of prognosis were analyzed by Cox’s proportional hazards regression model. Results Laboratory parameters such as WBC, PLT count, albumin (ALB) , TBil, ALT and total cholesterol (TC) levels were different among the three groups (H=11.22, 159.00, 59.13, 21.68, 92.15 and 33.24, P all<0.05) . The incidence rate of bacterial infections, acute kidney injury (AKI) and gastrointestinal bleeding within 28 days were also significantly different among the three groups (χ2=20.03, 16.07 and 14.46, P all<0.05) . The 28-day mortality rates in type A, B and C group were 22.2%, 27.1% and 37.6%, respectively, with a significant difference (χ2=7.96, P <0.05) . For type A ACLF patients, international normalized ratio (INR) , bacterial infections, hepatic encephalopathy (HE) and AKI were independent risk factors of 28-day mortality. In addition, age, WBC, TBil, bacterial infections, HE and AKI were the risk factors of type B. HE and AKI were the risk factors of type C. Conclusions The classification recommended by WGO is suitable for HBV-ACLF patients in China. The clinical characteristics and prognosis of three types are different, which is beneficial to the administration and management of clinical patients. Key words: Hepatitis B virus; Acute-on-chronic liver failure; World Gastroenterology Organization; Classification; Prognosis analysis