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.	谢倩. 血浆置换相关的非生物型人工肝治疗慢加急性(亚急性)肝衰竭近期疗效及费效比分析. 重庆: 重庆医科大学, 2020.
14.	中华医学会感染病学分会肝衰竭与人工肝学组. 非生物型人工肝治疗肝衰竭指南(2016 年版). 中华临床感染病杂志, 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.	吴春波, 周明雪, 孟彦, 等. 非生物型人工肝的应用及研究进展. 生物医学工程与临床, 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.	Grønbæk H, Rødgaard-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.	余叶. sCD163 对乙肝慢加急肝衰竭患者人工肝治疗预后的预测价值. 杭州: 浙江大学, 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.	吴云辉, 谢新生, 邓敏. 血清 M30 和 M65 水平变化对乙型肝炎病毒相关慢加急性肝衰竭患者人工肝治疗短期预后的预测价值. 中华传染病杂志, 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.	王鹭, 吴晓娟, 蔡蓓, 等. 胱抑素 C 估算肾小球滤过率对人工肝治疗 HBV 相关性慢加急性肝衰竭短期预后的预测价值. 四川大学学报(医学版), 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.	杨文龙, 孙水林, 周锡进, 等. 终末期肝病模型评分与 Child-Turcotte-Pugh 分级对非生物型人工肝治疗乙型肝炎相关性肝衰竭患者预测价值的研究. 中华危重症医学杂志(电子版), 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, 邵建国, 顾尔莉. 总胆红素反弹率对人工肝治疗慢加亚急性肝功能衰竭的短期预测. 中华传染病杂志, 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.	黄振华, 何关, 许丽霞, 等. NLR 联合 MLR 对乙型肝炎病毒相关慢加急性肝衰竭患者人工肝治疗短期预后的预测价值. 中国现代医学杂志 2020, 30(17): 13-19.
41.	朱立娜, 黄初军, 赵秋燕, 等. 组合型人工肝对肝功能衰竭患者血清 Th1/Th2 型细胞因子的影响. 临床消化病杂志, 2020, 32(1): 41-45.
42.	张聪, 曾爱中. 细胞因子与慢加急性肝衰竭的关系及人工肝治疗的影响. 重庆医学, 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. 谢倩. 血浆置换相关的非生物型人工肝治疗慢加急性(亚急性)肝衰竭近期疗效及费效比分析. 重庆: 重庆医科大学, 2020.
14. 中华医学会感染病学分会肝衰竭与人工肝学组. 非生物型人工肝治疗肝衰竭指南(2016 年版). 中华临床感染病杂志, 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. 吴春波, 周明雪, 孟彦, 等. 非生物型人工肝的应用及研究进展. 生物医学工程与临床, 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. Grønbæk H, Rødgaard-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. 余叶. sCD163 对乙肝慢加急肝衰竭患者人工肝治疗预后的预测价值. 杭州: 浙江大学, 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. 吴云辉, 谢新生, 邓敏. 血清 M30 和 M65 水平变化对乙型肝炎病毒相关慢加急性肝衰竭患者人工肝治疗短期预后的预测价值. 中华传染病杂志, 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. 王鹭, 吴晓娟, 蔡蓓, 等. 胱抑素 C 估算肾小球滤过率对人工肝治疗 HBV 相关性慢加急性肝衰竭短期预后的预测价值. 四川大学学报(医学版), 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. 杨文龙, 孙水林, 周锡进, 等. 终末期肝病模型评分与 Child-Turcotte-Pugh 分级对非生物型人工肝治疗乙型肝炎相关性肝衰竭患者预测价值的研究. 中华危重症医学杂志(电子版), 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, 邵建国, 顾尔莉. 总胆红素反弹率对人工肝治疗慢加亚急性肝功能衰竭的短期预测. 中华传染病杂志, 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. 黄振华, 何关, 许丽霞, 等. NLR 联合 MLR 对乙型肝炎病毒相关慢加急性肝衰竭患者人工肝治疗短期预后的预测价值. 中国现代医学杂志 2020, 30(17): 13-19.
41. 朱立娜, 黄初军, 赵秋燕, 等. 组合型人工肝对肝功能衰竭患者血清 Th1/Th2 型细胞因子的影响. 临床消化病杂志, 2020, 32(1): 41-45.
42. 张聪, 曾爱中. 细胞因子与慢加急性肝衰竭的关系及人工肝治疗的影响. 重庆医学, 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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