[Diagnostic criteria for HBV-related acute-on-chronic pre-liver failure].

OBJECTIVE: To investigate the diagnostic criteria for HBV-related acute-on-chronic pre-liver failure (pre-ACLF) which can effectively predict the risk of liver failure.

METHODS: A total of 1279 patients with severe icteric chronic hepatitis B (CHB) and/or severe acute exacerbation of CHB were enrolled. The influence of serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBil), international normalized ratio (INR) of prothrombin time, sex, and age on the incidence rate of acute-on-chronic liver failure (ACLF) was analyzed, the diagnostic criteria for pre-ACLF and predictive model for ACLF were developed. The chi-square test was used for comparison of categorical variables, and the independent samples t-test was used for continuous data; multivariate logistic regression analysis was performed to evaluate the risk of liver failure.

RESULTS: The baseline serum levels of ALT, AST, and TBil, and INR were independent risk factors for liver failure (P < 0.05). The diagnostic criteria for pre-ACLF were as follows: (1) INR≥1.30; (2) AST≥10×upper limit of normal (ULN) and obvious jaundice (TBil≥51.3 μmol/L), or TBil≥342.0 μmol/L. These criteria had a positive predictive value of 45.9%, a negative predictive value of 89.8%, a sensitivity of 69.1%, and a specificity of 76.9%. The predictive model for the risk of ACLF was PY = 1=e(X)/(1+e(X)) (PY represented positive results of logistic regression analysis), X = -10.245+0.026×AST(ULN)-0.025×AST(ULN)+0.046×TBil(mg/dl) + 4.642×INR+0.049×age(years). The patients with higher PY values tended to have a higher incidence rate of ACLF. The incidence rate of ACLF was 75.3% in patients with PY≥0.60, more than 50% in patients with a PY value of 0.40-0.59, and 1.8% in patients with PY < 0.10 (P < 0.01).

CONCLUSION: The diagnostic criteria for pre-ACLF and predictive model can effectively evaluate the risk of HBV-related ACLF.