Nomogram Analysis for HBV Related Acute-on-chronic Liver Failure

NCT03992898 | Completed DMC

• 1 other identifier: Survival Study Cohort(SSC001)
• Study Type: observational
• Target: 2,739
• Locations: 1 country
• Sites: 1

Brief Summary

Acute-on-chronic liver failure (ACLF) is an acute deterioration of chronic liver diseases, which progresses rapidly, with a mortality rate of more than 50%.MELD score is used to evaluate the patients' condition. However, MELD score only concerned about the variables of total bilirubin, international normalize ratio (INR) and creatinine which is not enough to access ACLF patients' condition accurately. Scholars of US and China suggested to divided ACLF patients into 3 subgroups base on the different "chronic liver disease" . Type A ACLF patients have chronic liver disease without cirrhosis. Type B ACLF patients with compensated cirrhosis, while type C ACLF patients with decompensated cirrhosis. Currently, no studies have assessed the prognosis of different types of ACLF patients, especially for HBV-related ACLF patients. Investigators conducted a retrospective study which enrolls HBV-related ACLF patients between January 2010 and March 2018 in the Third Affiliated Hospital of Sun Yat-sen University. Clinical data, survival time and information regarding liver transplantation after enrolment were collected. A nomogram was formulated based on the results of multivariable Cox regression analysis. The performance of the nomogram was evaluated by the concordance index (C-index) and assessed by comparing nomogram-predicted vs observed Kaplan-Meier estimates of survival probability, and bootstraps with 1000 resamples were applied to these activities. Comparisons between the nomogram, MELD Score，MELD-Na Score and CTP Score in the entire population were performed and were tested by the C-index. A larger C-index indicated more accurate prognostic stratification.

Conditions

Liver Failure

Outcome Measures

Primary Outcomes (1)

• survival status

  Patients will be follow-up for 90 days until death or received liver transplantation. And survival days of each patients will be recorded.

  90 days

Study Arms (2)

Chronic hepatitis cohort

In this cohort, patients were defined as type A acute-on-chronic liver failure (ACLF) patients who have chronic liver disease but without cirrhosis.

Other: No special intervention was suitable for this observational study

Cirrhosis cohort

In this cohort, patients were defined as type B and type C ACLF patients with cirrhosis.

Other: No special intervention was suitable for this observational study

Interventions

No special intervention was suitable for this observational study OTHER

Investegators divided patients into 3 corhort according to the liver condition at enrollment (i.e. chronic liver disease, compemsated cirrhosis, decompensated cirrhosis). All patients received standard medical treatment, including nutritional supplementation; administration of human serum albumin, fresh frozen plasma, antivirus treatment and appropriate treatment for complications. No special intervention was suitable for this observational study.

Chronic hepatitis cohort; Cirrhosis cohort

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

The investigators will enroll a retrospective cohort of HBV related acute-on-chronic liver failure patients who were admitted to The Third affiliated Hospital of Sun Yat-sen University from January 2010 to March 2018.

You may qualify if:

• Age ≥ 18 years; Serum total bilirubin ≥ 10 mg/dl; International normalized ratio≥1.5 or prothrombin activity \<40%; Complicated within 4 weeks by ascites and/or encephalopathy; Positive serum hepatitis B surface antigen for more than 6 months.

You may not qualify if:

• Drug induce liver diseases; Autoimmune liver diseases; Alcohol or drug abusers (average alcohol consumption \>40g/d for men, \>20g/d for women); Liver diseases caused by metabolic factors; Superinfection with hepatitis A, C, D, E viruses; Infected by HIV virus; Pregnancy or lactation; Liver failure caused by recurrence of hepatitis b after transplantation.

Sponsors & Collaborators

• Sun Yat-sen University: lead

Study Sites (1)

The Third Affiliated Hospital of Sun Yat-sen University

Guangzhou, Guangdong, 510630, China

Location

Related Publications (12)

• Lin B, Pan CQ, Xie D, Xie J, Xie S, Zhang X, Wu B, Lin C, Gao Z. Entecavir improves the outcome of acute-on-chronic liver failure due to the acute exacerbation of chronic hepatitis B. Hepatol Int. 2013 Jun;7(2):460-7. doi: 10.1007/s12072-012-9415-y. Epub 2013 Feb 11.

  PMID: 26201778 BACKGROUND

• Duseja A, Choudhary NS, Gupta S, Dhiman RK, Chawla Y. APACHE II score is superior to SOFA, CTP and MELD in predicting the short-term mortality in patients with acute-on-chronic liver failure (ACLF). J Dig Dis. 2013 Sep;14(9):484-90. doi: 10.1111/1751-2980.12074.

  PMID: 23692973 BACKGROUND

• Peng Y, Qi X, Tang S, Deng H, Li J, Ning Z, Dai J, Hou F, Zhao J, Wang R, Guo X. Child-Pugh, MELD, and ALBI scores for predicting the in-hospital mortality in cirrhotic patients with acute-on-chronic liver failure. Expert Rev Gastroenterol Hepatol. 2016 Aug;10(8):971-80. doi: 10.1080/17474124.2016.1177788. Epub 2016 Apr 25.

  PMID: 27070325 BACKGROUND

• Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, Durand F, Gustot T, Saliba F, Domenicali M, Gerbes A, Wendon J, Alessandria C, Laleman W, Zeuzem S, Trebicka J, Bernardi M, Arroyo V; CANONIC Study Investigators of the EASL-CLIF Consortium. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013 Jun;144(7):1426-37, 1437.e1-9. doi: 10.1053/j.gastro.2013.02.042. Epub 2013 Mar 6.

  PMID: 23474284 BACKGROUND

• Jalan R, Pavesi M, Saliba F, Amoros A, Fernandez J, Holland-Fischer P, Sawhney R, Mookerjee R, Caraceni P, Moreau R, Gines P, Durand F, Angeli P, Alessandria C, Laleman W, Trebicka J, Samuel D, Zeuzem S, Gustot T, Gerbes AL, Wendon J, Bernardi M, Arroyo V; CANONIC Study Investigators; EASL-CLIF Consortium. The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure. J Hepatol. 2015 Apr;62(4):831-40. doi: 10.1016/j.jhep.2014.11.012. Epub 2014 Nov 22.

  PMID: 25463539 BACKGROUND

• Silva PE, Fayad L, Lazzarotto C, Ronsoni MF, Bazzo ML, Colombo BS, Dantas-Correa EB, Narciso-Schiavon JL, Schiavon LL. Single-centre validation of the EASL-CLIF consortium definition of acute-on-chronic liver failure and CLIF-SOFA for prediction of mortality in cirrhosis. Liver Int. 2015 May;35(5):1516-23. doi: 10.1111/liv.12597. Epub 2014 Jun 6.

  PMID: 24840673 BACKGROUND

• Jalan R, Yurdaydin C, Bajaj JS, Acharya SK, Arroyo V, Lin HC, Gines P, Kim WR, Kamath PS; World Gastroenterology Organization Working Party. Toward an improved definition of acute-on-chronic liver failure. Gastroenterology. 2014 Jul;147(1):4-10. doi: 10.1053/j.gastro.2014.05.005. Epub 2014 May 20. No abstract available.

  PMID: 24853409 BACKGROUND

• Luo Y, Xu Y, Li M, Xie Y, Gong G. A new multiparameter integrated MELD model for prognosis of HBV-related acute-on-chronic liver failure. Medicine (Baltimore). 2016 Aug;95(34):e4696. doi: 10.1097/MD.0000000000004696.

  PMID: 27559979 BACKGROUND

• Shi KQ, Cai YJ, Lin Z, Dong JZ, Wu JM, Wang XD, Song M, Wang YQ, Chen YP. Development and validation of a prognostic nomogram for acute-on-chronic hepatitis B liver failure. J Gastroenterol Hepatol. 2017 Feb;32(2):497-505. doi: 10.1111/jgh.13502.

  PMID: 27490495 BACKGROUND

• Chen JF, Weng WZ, Huang M, Peng XH, Zhang J, Xiong J, He JR, Zhang SQ, Cao HJ, Gao B, Lin DN, Gao J, Gao ZL, Lin BL. The impact of serum thyroid-stimulation hormone levels on the outcome of hepatitis B virus related acute-on-chronic liver failure: an observational study. BMC Gastroenterol. 2022 Jul 7;22(1):330. doi: 10.1186/s12876-022-02406-7.

  PMID: 35799116 DERIVED

• Weng WZ, Chen JF, Peng XH, Huang M, Zhang J, Xiong J, Cao HJ, Lin BL. Risk factors for underlying comorbidities and complications in patients with hepatitis B virus-related acute-on-chronic liver failure. Epidemiol Infect. 2022 Jul 5;150:e147. doi: 10.1017/S0950268822001169.

  PMID: 35788251 DERIVED

• Chen JF, Weng WZ, Huang M, Peng XH, He JR, Zhang J, Xiong J, Zhang SQ, Cao HJ, Gao B, Lin DN, Gao J, Gao ZL, Lin BL. Derivation and Validation of a Nomogram for Predicting 90-Day Survival in Patients With HBV-Related Acute-on-Chronic Liver Failure. Front Med (Lausanne). 2021 Jun 16;8:692669. doi: 10.3389/fmed.2021.692669. eCollection 2021.

  PMID: 34222294 DERIVED

MeSH Terms

Conditions

Liver Failure

Condition Hierarchy (Ancestors)

Hepatic Insufficiency; Liver Diseases; Digestive System Diseases

Study Officials

• Bingliang Lin, Doctor

  Third Affiliated Hospital, Sun Yat-Sen University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Clinical Professor

Study Record Dates

• First Submitted: June 19, 2019
• First Posted: June 20, 2019
• Study Start: January 1, 2019
• Primary Completion: October 1, 2019
• Study Completion: November 1, 2019
• Last Updated: January 6, 2020

Record last verified: 2020-01

Data Sharing

• IPD Sharing: Will not share

Locations

CN (1)