Progress on prognosis of hepatitis B virus related acute-on-chronic liver failure with artificial liver support system therapy in emergency department_West China Medical Journal

Authors：

NI Xiaoyu ^1,2 , SUN Yao ^1,2 , WANG Xinglei ^1,2 ,  ZHANG Shu ¹

1. Department of Emergency, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

ZHANG Shu, Email: zhangs@wchscu.cn

Keywords：

Artificial liver; Hepatitis B virus; Liver failure; Prognosis

DOI：

10.7507/1002-0179.202110158

Video：

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Hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) has the characteristics of rapid progress and high mortality. Artificial liver support system (ALSS) is far superior to standard drug therapy in the treatment of such patients, and is widely used in emergency. ALSS is the use of external mechanical or biological devices to replace a part of the damaged liver function, divided into bioartificial, non-bioartificial liver and a combination of the two. At present, there is no unified sensitive prognostic index and recognized prognostic model for HBV-ACLF in artificial liver treatment. This paper reviews the research progress of prognosis evaluation of ALSS in the treatment of HBV-ACLF, in order to provide reference for clinicians and researchers

Citation： NI Xiaoyu, SUN Yao, WANG Xinglei, ZHANG Shu. Progress on prognosis of hepatitis B virus related acute-on-chronic liver failure with artificial liver support system therapy in emergency department. West China Medical Journal, 2021, 36(11): 1603-1607. doi: 10.7507/1002-0179.202110158 Copy

1.	Sarin SK, Choudhury A. Acute-on-chronic liver failure: terminology, mechanisms and management. Nat Rev Gastroenterol Hepatol, 2016, 13(3): 131-149.
2.	Li J, Liang X, Jiang J, et al. PBMC transcriptomics identifies immune-metabolism disorder during the development of HBV-ACLF. Gut, 2021: gutjnl-2020-323395.
3.	Moreau R, Gao B, Papp M, et al. Acute-on-chronic liver failure: a distinct clinical syndrome. J Hepatol, 2021, 75(Suppl 1): S27-S35.
4.	Casulleras M, Zhang IW, López-Vicario C, et al. Leukocytes, systemic inflammation and immunopathology in acute-on-chronic liver failure. Cells-Basel, 2020, 9(12): 2632.
5.	Arroyo V, Jalan R. Acute-on-chronic liver failure: definition, diagnosis, and clinical characteristics. Semin Liver Dis, 2016, 36(2): 109-116.
6.	Jalan R, Moreau R, Kamath PS, et al. Acute-on-chronic liver failure: a distinct clinical condition. Semin Liver Dis, 2016, 36(2): 107-108.
7.	Xiao LL, Xu XW, Huang KZ, et al. Artificial liver support system improves short-term outcomes of patients with HBV-associated acute-on-chronic liver failure: a propensity score analysis. Biomed Res Int, 2019, 2019: 3757149.
8.	Zhao RH, Shi Y, Zhao H, et al. Acute-on-chronic liver failure in chronic hepatitis B: an update. Expert Rev Gastroenterol Hepatol, 2018, 12(4): 341-350.
9.	Chen EQ, Zeng F, Zhou LY, et al. Early warning and clinical outcome prediction of acute-on-chronic hepatitis B liver failure. World J Gastroenterol, 2015, 21(42): 11964-11973.
10.	Larsen FS. Artificial liver support in acute and acute-on-chronic liver failure. Curr Opin Crit Care, 2019, 25(2): 187-191.
11.	Saliba F, Samuel D. Artificial liver support: a real step forward. Minerva Med, 2015, 106(1): 35-43.
12.	Qin G, Shao JG, Wang B, et al. Artificial liver support system improves short- and long-term outcomes of patients with HBV-associated acute-on-chronic liver failure: a single-center experience. Medicine (Baltimore), 2014, 93(28): e338.
13.	謝倩. 血漿置換相關的非生物型人工肝治療慢加急性(亞急性)肝衰竭近期療效及費效比分析. 重慶: 重慶醫科大學, 2020.
14.	中華醫學會感染病學分會肝衰竭與人工肝學組. 非生物型人工肝治療肝衰竭指南(2016 年版). 中華臨床感染病雜志, 2016, 9(2): 97-103.
15.	Liu JP, Gluud LL, Als-Nielsen B, et al. Artificial and bioartificial support systems for liver failure. Cochrane Database Syst Rev, 2004, 2004(1): CD003628.
16.	Struecker B, Raschzok N, Sauer IM. Liver support strategies: cutting-edge technologies. Nat Rev Gastroenterol Hepatol, 2014, 11(3): 166-176.
17.	吳春波, 周明雪, 孟彥, 等. 非生物型人工肝的應用及研究進展. 生物醫學工程與臨床, 2021, 25(5): 634-638.
18.	Dominik A, Stange J. Similarities, differences, and potential synergies in the mechanism of action of albumin dialysis using the MARS albumin dialysis device and the cytosorb hemoperfusion device in the treatment of liver failure. Blood Purif, 2021, 50(1): 119-128.
19.	Yao J, Li S, Zhou L, et al. Therapeutic effect of double plasma molecular adsorption system and sequential half-dose plasma exchange in patients with HBV-related acute-on-chronic liver failure. J Clin Apher, 2019, 34(4): 392-398.
20.	Yuan L, Zeng BM, Liu LL, et al. Risk factors for progression to acute-on-chronic liver failure during severe acute exacerbation of chronic hepatitis B virus infection. World J Gastroenterol, 2019, 25(19): 2327-2337.
21.	Zhang Q, Han T, Li Y, et al. Predictors of progression into acute-on-chronic liver failure from acute deterioration of pre-existing chronic liver disease. Hepatol Res, 2016, 46(4): 320-328.
22.	Etzerodt A, Moestrup SK. CD163 and inflammation: biological, diagnostic, and therapeutic aspects. Antioxid Redox Signal, 2013, 18(17): 2352-2363.
23.	Gr?nb?k H, R?dgaard-Hansen S, Aagaard NK, et al. Macrophage activation markers predict mortality in patients with liver cirrhosis without or with acute-on-chronic liver failure (ACLF). J Hepatol, 2016, 64(4): 813-822.
24.	余葉. sCD163 對乙肝慢加急肝衰竭患者人工肝治療預后的預測價值. 杭州: 浙江大學, 2016.
25.	Hofer S, Brenner T, Bopp C, et al. Cell death serum biomarkers are early predictors for survival in severe septic patients with hepatic dysfunction. Crit Care, 2009, 13(3): R93.
26.	Feldstein AE, Wieckowska A, Lopez AR, et al. Cytokeratin-18 fragment levels as noninvasive biomarkers for nonalcoholic steatohepatitis: a multicenter validation study. Hepatology, 2009, 50(4): 1072-1078.
27.	Cusi K, Chang Z, Harrison S, et al. Limited value of plasma cytokeratin-18 as a biomarker for NASH and fibrosis in patients with non-alcoholic fatty liver disease. J Hepatol, 2014, 60(1): 167-174.
28.	吳云輝, 謝新生, 鄧敏. 血清 M30 和 M65 水平變化對乙型肝炎病毒相關慢加急性肝衰竭患者人工肝治療短期預后的預測價值. 中華傳染病雜志, 2019, 37(11): 661-666.
29.	Zheng SJ, Liu S, Liu M, et al. Prognostic value of M30/M65 for outcome of hepatitis B virus-related acute-on-chronic liver failure. World J Gastroenterol, 2014, 20(9): 2403-2411.
30.	Krones E, Fickert P, Zitta S, et al. The chronic kidney disease epidemiology collaboration equation combining creatinine and cystatin C accurately assesses renal function in patients with cirrhosis. BMC Nephrol, 2015, 16: 196.
31.	Adachi M, Tanaka A, Aiso M, et al. Benefit of cystatin C in evaluation of renal function and prediction of survival in patients with cirrhosis. Hepatol Res, 2015, 45(13): 1299-1306.
32.	Yoo JJ, Kim SG, Kim YS, et al. Estimation of renal function in patients with liver cirrhosis: impact of muscle mass and sex. J Hepatol, 2019, 70(5): 847-854.
33.	Markwardt D, Holdt L, Steib C, et al. Plasma cystatin C is a predictor of renal dysfunction, acute-on-chronic liver failure, and mortality in patients with acutely decompensated liver cirrhosis. Hepatology, 2017, 66(4): 1232-1241.
34.	王鷺, 吳曉娟, 蔡蓓, 等. 胱抑素 C 估算腎小球濾過率對人工肝治療 HBV 相關性慢加急性肝衰竭短期預后的預測價值. 四川大學學報(醫學版), 2021, 52(5): 862-867.
35.	Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology, 2000, 31(4): 864-871.
36.	楊文龍, 孫水林, 周錫進, 等. 終末期肝病模型評分與 Child-Turcotte-Pugh 分級對非生物型人工肝治療乙型肝炎相關性肝衰竭患者預測價值的研究. 中華危重癥醫學雜志(電子版), 2016, 9(1): 20-27.
37.	Du L, Ma Y, Zhou S, et al. A prognostic score for patients with acute-on-chronic liver failure treated with plasma exchange-centered artificial liver support system. Sci Rep, 2021, 11(1): 1469.
38.	王忠成, 邵建國, 顧爾莉. 總膽紅素反彈率對人工肝治療慢加亞急性肝功能衰竭的短期預測. 中華傳染病雜志, 2013, 31(11): 678-680.
39.	Cai J, Wang K, Han T, et al. Evaluation of prognostic values of inflammation-based makers in patients with HBV-related acute-on-chronic liver failure. Medicine (Baltimore), 2018, 97(46): e13324.
40.	黃振華, 何關, 許麗霞, 等. NLR 聯合 MLR 對乙型肝炎病毒相關慢加急性肝衰竭患者人工肝治療短期預后的預測價值. 中國現代醫學雜志 2020, 30(17): 13-19.
41.	朱立娜, 黃初軍, 趙秋燕, 等. 組合型人工肝對肝功能衰竭患者血清 Th1/Th2 型細胞因子的影響. 臨床消化病雜志, 2020, 32(1): 41-45.
42.	張聰, 曾愛中. 細胞因子與慢加急性肝衰竭的關系及人工肝治療的影響. 重慶醫學, 2014, 43(25): 3379-3381.
43.	Huang K, Ji F, Xie Z, Wu D, et al. Artificial liver support system therapy in acute-on-chronic hepatitis B liver failure: classification and regression tree analysis. Sci Rep, 2019, 9(1): 16462.

1. Sarin SK, Choudhury A. Acute-on-chronic liver failure: terminology, mechanisms and management. Nat Rev Gastroenterol Hepatol, 2016, 13(3): 131-149.
2. Li J, Liang X, Jiang J, et al. PBMC transcriptomics identifies immune-metabolism disorder during the development of HBV-ACLF. Gut, 2021: gutjnl-2020-323395.
3. Moreau R, Gao B, Papp M, et al. Acute-on-chronic liver failure: a distinct clinical syndrome. J Hepatol, 2021, 75(Suppl 1): S27-S35.
4. Casulleras M, Zhang IW, López-Vicario C, et al. Leukocytes, systemic inflammation and immunopathology in acute-on-chronic liver failure. Cells-Basel, 2020, 9(12): 2632.
5. Arroyo V, Jalan R. Acute-on-chronic liver failure: definition, diagnosis, and clinical characteristics. Semin Liver Dis, 2016, 36(2): 109-116.
6. Jalan R, Moreau R, Kamath PS, et al. Acute-on-chronic liver failure: a distinct clinical condition. Semin Liver Dis, 2016, 36(2): 107-108.
7. Xiao LL, Xu XW, Huang KZ, et al. Artificial liver support system improves short-term outcomes of patients with HBV-associated acute-on-chronic liver failure: a propensity score analysis. Biomed Res Int, 2019, 2019: 3757149.
8. Zhao RH, Shi Y, Zhao H, et al. Acute-on-chronic liver failure in chronic hepatitis B: an update. Expert Rev Gastroenterol Hepatol, 2018, 12(4): 341-350.
9. Chen EQ, Zeng F, Zhou LY, et al. Early warning and clinical outcome prediction of acute-on-chronic hepatitis B liver failure. World J Gastroenterol, 2015, 21(42): 11964-11973.
10. Larsen FS. Artificial liver support in acute and acute-on-chronic liver failure. Curr Opin Crit Care, 2019, 25(2): 187-191.
11. Saliba F, Samuel D. Artificial liver support: a real step forward. Minerva Med, 2015, 106(1): 35-43.
12. Qin G, Shao JG, Wang B, et al. Artificial liver support system improves short- and long-term outcomes of patients with HBV-associated acute-on-chronic liver failure: a single-center experience. Medicine (Baltimore), 2014, 93(28): e338.
13. 謝倩. 血漿置換相關的非生物型人工肝治療慢加急性(亞急性)肝衰竭近期療效及費效比分析. 重慶: 重慶醫科大學, 2020.
14. 中華醫學會感染病學分會肝衰竭與人工肝學組. 非生物型人工肝治療肝衰竭指南(2016 年版). 中華臨床感染病雜志, 2016, 9(2): 97-103.
15. Liu JP, Gluud LL, Als-Nielsen B, et al. Artificial and bioartificial support systems for liver failure. Cochrane Database Syst Rev, 2004, 2004(1): CD003628.
16. Struecker B, Raschzok N, Sauer IM. Liver support strategies: cutting-edge technologies. Nat Rev Gastroenterol Hepatol, 2014, 11(3): 166-176.
17. 吳春波, 周明雪, 孟彥, 等. 非生物型人工肝的應用及研究進展. 生物醫學工程與臨床, 2021, 25(5): 634-638.
18. Dominik A, Stange J. Similarities, differences, and potential synergies in the mechanism of action of albumin dialysis using the MARS albumin dialysis device and the cytosorb hemoperfusion device in the treatment of liver failure. Blood Purif, 2021, 50(1): 119-128.
19. Yao J, Li S, Zhou L, et al. Therapeutic effect of double plasma molecular adsorption system and sequential half-dose plasma exchange in patients with HBV-related acute-on-chronic liver failure. J Clin Apher, 2019, 34(4): 392-398.
20. Yuan L, Zeng BM, Liu LL, et al. Risk factors for progression to acute-on-chronic liver failure during severe acute exacerbation of chronic hepatitis B virus infection. World J Gastroenterol, 2019, 25(19): 2327-2337.
21. Zhang Q, Han T, Li Y, et al. Predictors of progression into acute-on-chronic liver failure from acute deterioration of pre-existing chronic liver disease. Hepatol Res, 2016, 46(4): 320-328.
22. Etzerodt A, Moestrup SK. CD163 and inflammation: biological, diagnostic, and therapeutic aspects. Antioxid Redox Signal, 2013, 18(17): 2352-2363.
23. Gr?nb?k H, R?dgaard-Hansen S, Aagaard NK, et al. Macrophage activation markers predict mortality in patients with liver cirrhosis without or with acute-on-chronic liver failure (ACLF). J Hepatol, 2016, 64(4): 813-822.
24. 余葉. sCD163 對乙肝慢加急肝衰竭患者人工肝治療預后的預測價值. 杭州: 浙江大學, 2016.
25. Hofer S, Brenner T, Bopp C, et al. Cell death serum biomarkers are early predictors for survival in severe septic patients with hepatic dysfunction. Crit Care, 2009, 13(3): R93.
26. Feldstein AE, Wieckowska A, Lopez AR, et al. Cytokeratin-18 fragment levels as noninvasive biomarkers for nonalcoholic steatohepatitis: a multicenter validation study. Hepatology, 2009, 50(4): 1072-1078.
27. Cusi K, Chang Z, Harrison S, et al. Limited value of plasma cytokeratin-18 as a biomarker for NASH and fibrosis in patients with non-alcoholic fatty liver disease. J Hepatol, 2014, 60(1): 167-174.
28. 吳云輝, 謝新生, 鄧敏. 血清 M30 和 M65 水平變化對乙型肝炎病毒相關慢加急性肝衰竭患者人工肝治療短期預后的預測價值. 中華傳染病雜志, 2019, 37(11): 661-666.
29. Zheng SJ, Liu S, Liu M, et al. Prognostic value of M30/M65 for outcome of hepatitis B virus-related acute-on-chronic liver failure. World J Gastroenterol, 2014, 20(9): 2403-2411.
30. Krones E, Fickert P, Zitta S, et al. The chronic kidney disease epidemiology collaboration equation combining creatinine and cystatin C accurately assesses renal function in patients with cirrhosis. BMC Nephrol, 2015, 16: 196.
31. Adachi M, Tanaka A, Aiso M, et al. Benefit of cystatin C in evaluation of renal function and prediction of survival in patients with cirrhosis. Hepatol Res, 2015, 45(13): 1299-1306.
32. Yoo JJ, Kim SG, Kim YS, et al. Estimation of renal function in patients with liver cirrhosis: impact of muscle mass and sex. J Hepatol, 2019, 70(5): 847-854.
33. Markwardt D, Holdt L, Steib C, et al. Plasma cystatin C is a predictor of renal dysfunction, acute-on-chronic liver failure, and mortality in patients with acutely decompensated liver cirrhosis. Hepatology, 2017, 66(4): 1232-1241.
34. 王鷺, 吳曉娟, 蔡蓓, 等. 胱抑素 C 估算腎小球濾過率對人工肝治療 HBV 相關性慢加急性肝衰竭短期預后的預測價值. 四川大學學報(醫學版), 2021, 52(5): 862-867.
35. Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology, 2000, 31(4): 864-871.
36. 楊文龍, 孫水林, 周錫進, 等. 終末期肝病模型評分與 Child-Turcotte-Pugh 分級對非生物型人工肝治療乙型肝炎相關性肝衰竭患者預測價值的研究. 中華危重癥醫學雜志(電子版), 2016, 9(1): 20-27.
37. Du L, Ma Y, Zhou S, et al. A prognostic score for patients with acute-on-chronic liver failure treated with plasma exchange-centered artificial liver support system. Sci Rep, 2021, 11(1): 1469.
38. 王忠成, 邵建國, 顧爾莉. 總膽紅素反彈率對人工肝治療慢加亞急性肝功能衰竭的短期預測. 中華傳染病雜志, 2013, 31(11): 678-680.
39. Cai J, Wang K, Han T, et al. Evaluation of prognostic values of inflammation-based makers in patients with HBV-related acute-on-chronic liver failure. Medicine (Baltimore), 2018, 97(46): e13324.
40. 黃振華, 何關, 許麗霞, 等. NLR 聯合 MLR 對乙型肝炎病毒相關慢加急性肝衰竭患者人工肝治療短期預后的預測價值. 中國現代醫學雜志 2020, 30(17): 13-19.
41. 朱立娜, 黃初軍, 趙秋燕, 等. 組合型人工肝對肝功能衰竭患者血清 Th1/Th2 型細胞因子的影響. 臨床消化病雜志, 2020, 32(1): 41-45.
42. 張聰, 曾愛中. 細胞因子與慢加急性肝衰竭的關系及人工肝治療的影響. 重慶醫學, 2014, 43(25): 3379-3381.
43. Huang K, Ji F, Xie Z, Wu D, et al. Artificial liver support system therapy in acute-on-chronic hepatitis B liver failure: classification and regression tree analysis. Sci Rep, 2019, 9(1): 16462.

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