A multi-subgroup predictive model based on clinical parameters and laboratory biomarkers to predict in-hospital outcomes of plasma exchange-centered artificial liver treatment in patients with hepatitis B virus-related acute-on-chronic liver failure

Liu, Jie; Shi, Xiaoguang; Xu, Hongmin; Tian, Yaping; Ren, Chaoyi; Li, Jianbiao; Shan, Shiguang; Liu, Shuye

doi:10.3389/fcimb.2023.1107351

Cited by 3 publications

(1 citation statement)

References 44 publications

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“…Among these factors, age is closely related to the severity of liver disease and poor prognosis 24 . Other studies have reported that age, PT, total bilirubin, infection, and hepatic encephalopathy are also independent factors for the prognosis of ACLF 25 , 26 . The DSM-ACLF (day-3) score includes the factors of blood glucose, triglycerides, very low-density lipoprotein and fibrin.…”

Section: Discussionmentioning

confidence: 92%

Construction of a novel prognostic scoring model for HBV-ACLF liver failure based on dynamic data

Cai,

Wang,

Zhu

et al. 2024

Sci Rep

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Early prognostic assessment of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is important for guiding clinical management and reducing mortality. The aim of this study was to dynamically monitor the clinical characteristics of HBV-ACLF patients, thereby allowing the construction of a novel prognostic scoring model to predict the outcome of HBV-ACLF patients. Clinical data was prospectively collected for 518 patients with HBV-ACLF and randomly divided into training and validation sets. We constructed day-1, day-2, and day-(1 + 3) prognostic score models based on dynamic time points. The prognostic risk score constructed for day-3 was found to have the best predictive ability. The factors included in this scoring system, referred to as DSM-ACLF-D3, were age, hepatic encephalopathy, alkaline phosphatase, total bilirubin, triglycerides, very low-density lipoprotein, blood glucose, neutrophil count, fibrin, and INR. ROC analysis revealed the area under the curve predicted by DSM-ACLF-D3 for 28-day and 90-day mortality (0.901 and 0.889, respectively) was significantly better than those of five other scoring systems: COSSH-ACLF IIs (0.882 and 0.836), COSSH-ACLFs (0.863 and 0.832), CLIF-C ACLF (0.838 and 0.766), MELD (0.782 and 0.762) and MELD-Na (0.756 and 0.731). Dynamic monitoring of the changes in clinical factors can therefore significantly improve the accuracy of scoring models. Evaluation of the probability density function and risk stratification by DSM-ACLF-D3 also resulted in the best predictive values for mortality. The novel DSM-ACLF-D3 prognostic scoring model based on dynamic data can improve early warning, prediction and clinical management of HBV-ACLF patients.

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Section: Discussionmentioning

confidence: 92%

Construction of a novel prognostic scoring model for HBV-ACLF liver failure based on dynamic data

Cai,

Wang,

Zhu

et al. 2024

Sci Rep

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Comparative efficacy of double plasma molecular adsorption system combined with plasma exchange versus plasma exchange in treating acute‐on‐chronic liver failure due to hepatitis B: A meta‐analysis

Zhang,

Ma,

Wang

et al. 2024

J of Clinical Apheresis

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This meta‐analysis aims to evaluate the effectiveness of the double plasma molecular adsorption system (DPMAS) in combination with plasma exchange (PE) compared to plasma exchange alone in the treatment of Acute‐on‐Chronic liver failure (LF) caused by hepatitis B. Until August 31, 2023, a comprehensive search of databases including Embase, Chinese Medical Journal Full‐text Database, China Biomedical Literature Database, Wan Fang Medical Network, PubMed, and the Cochrane Library was carried out using keywords like “liver failure,” “acute‐on‐chronic liver failure,” “PE,” “DPMAS,” and related terms. The quality of the included studies was evaluated using QUADS (quality assessment of diagnostic accuracy studies). Software Revman 5.3 was used to examine the data, while Stata 15.1 was used to run Egger's test. Following thorough screening, 452 patients who received PE alone and 429 patients who received DPMAS in addition to PE were included. Every study that was included was of a high caliber. When comparing the DPMAS plus PE group to the PE alone group, the total bilirubin reduction was considerably higher (mean difference [MD] = −49.09, 95% confidence interval [CI]: −54.84 to −43.35, p < .00001). Prothrombin activity (PTA; MD = −1.53, 95% CI: −3.29 to −0.22, p = .09), albumin (ALB; MD = −0.58, 95% CI: −1.57 to 0.41, p = .25), prothrombin time (PT; MD = −0.07, 95% CI: −1.47 to 1.34, p = .92), and platelet count (PLT; MD = −0.08, 95% CI: −1.33 to 1.66, p = .90) did not differ significantly. The improvement in international standardized ratio (INR) was significantly greater in the PE group (MD = 0.07, 95% CI (0.03, 0.10), p = .0001). When combined with DPMAS, PE has been shown to be more effective in lowering total bilirubin levels. PE can also lower INR in individuals who have hepatitis B‐related ACLF. This therapeutic strategy also lessens the need for plasma transfusions.

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Characteristics of circulating immune cells in HBV-related acute-on-chronic liver failure following artificial liver treatment

Ju,

Jiang,

Zhong

et al. 2023

BMC Immunol

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Background and aim Liver failure, which is predominantly caused by hepatitis B (HBV) can be improved by an artificial liver support system (ALSS). This study investigated the phenotypic heterogeneity of immunocytes in patients with HBV-related acute-on-chronic liver failure (HBV-ACLF) before and after ALSS therapy. Methods A total of 22 patients with HBV-ACLF who received ALSS therapy were included in the study. Patients with Grade I according to the ACLF Research Consortium score were considered to have improved. Demographic and laboratory data were collected and analyzed during hospitalization. Immunological features of peripheral blood in the patients before and after ALSS were detected by mass cytometry analyses. Results In total, 12 patients improved and 10 patients did not. According to the immunological features data after ALSS, the proportion of circulating monocytes was significantly higher in non-improved patients, but there were fewer γδT cells compared with those in improved patients. Characterization of 37 cell clusters revealed that the frequency of effector CD8+ T (P = 0.003), CD4+ TCM (P = 0.033), CD4+ TEM (P = 0.039), and inhibitory natural killer (NK) cells (P = 0.029) decreased in HBV-ACLF patients after ALSS therapy. Sub group analyses after treatment showed that the improved patients had higher proportions of CD4+ TCM (P = 0.010), CD4+ TEM (P = 0.021), and γδT cells (P = 0.003) and a lower proportion of monocytes (P = 0.012) compared with the non-improved patients. Conclusions Changes in effector CD8+ T cells, effector and memory CD4+ T cells, and inhibitory NK cells are associated with ALSS treatment of HBV-ACLF. Moreover, monocytes and γδT cells exhibited the main differences when patients obtained different prognoses. The phenotypic heterogeneity of lymphocytes and monocytes may contribute to the prognosis of ALSS and future immunotherapy strategies.

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A multi-subgroup predictive model based on clinical parameters and laboratory biomarkers to predict in-hospital outcomes of plasma exchange-centered artificial liver treatment in patients with hepatitis B virus-related acute-on-chronic liver failure

Cited by 3 publications

References 44 publications

Construction of a novel prognostic scoring model for HBV-ACLF liver failure based on dynamic data

Construction of a novel prognostic scoring model for HBV-ACLF liver failure based on dynamic data

Comparative efficacy of double plasma molecular adsorption system combined with plasma exchange versus plasma exchange in treating acute‐on‐chronic liver failure due to hepatitis B: A meta‐analysis

Characteristics of circulating immune cells in HBV-related acute-on-chronic liver failure following artificial liver treatment

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