Antiviral Therapy for Acute-on-Chronic Liver Failure in Chronic Hepatitis B: Is It Too Late?

Chan, Henry Lik‐Yuen

doi:10.1007/s10620-010-1266-6

Cited by 6 publications

(3 citation statements)

References 22 publications

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“…The hepatitis B‐related ACLF (HB‐ACLF) was associated with a relative better prognosis than acute liver failure or fulminant hepatitis but was much more severe than conventional hepatitis B flare or exacerbation. Nucleoside analogue treatment could suppress the HBV replication effectively but did not improve 3‐month survival rate of patients with HB‐ACLF [3,4]. So far, liver transplantation is still the only one available therapeutic option for such patients.…”

Section: Introductionmentioning

confidence: 99%

Interleukin‐21 is upregulated in hepatitis B‐related acute‐on‐chronic liver failure and associated with severity of liver disease

Huang

et al. 2011

Journal of Viral Hepatitis

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The immune mechanism(s) that lead to hepatitis B-related acute-on-chronic liver failure (HB-ACLF) are poorly understood. Interleukin-21 is a newly discovered cytokine that is involved in autoimmune and inflammatory diseases. Its potential role in HB-ACLF remains unknown. The serum levels of 12 immune cytokines measured by cytometric bead arrays and the frequency of IL-21-secreting CD4+ T cells in peripheral blood mononuclear cells (PBMC) measured by intracellular cytokine staining were compared in moderate chronic hepatitis B (M-CHB, n = 20), severe chronic hepatitis B (S-CHB, n = 20), HB-ACLF (n = 39) and healthy controls (n = 10). PBMC from M-CHB patients or healthy subjects were stimulated with rhIL-21 in vitro, and cytokines in supernatants were measured by FlowCytomix. The frequencies of IL-21-secreting CD4+ T cells were higher in HB-ACLF (both P < 0.001) and S-CHB (P = 0.002 and 0.001) as compared to M-CHB patients and controls. Serum IL-21 levels were highest (P < 0.001) in HB-ACLF and positively associated with high MELD score (P = 0.001) and mortality (P = 0.038). Recovery from HB-ACLF was associated with reduced serum IL-21 levels (P = 0.003) and lower CD4+ IL-21(+) T-cell frequency (P = 0.006). The secretions of IL-1β (P < 0.001), IL-6 (P < 0.001), IL-10 (P < 0.001), IFN-γ (P = 0.001) and TNF-α (P = 0.042) from PBMC were significantly increased with rhIL-21 stimulation. In summary, IL-21 has a causal role in the development of severe liver inflammation, which is upregulated in HB-ACLF and associated with severity of liver disease.

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Section: Introductionmentioning

confidence: 99%

Interleukin‐21 is upregulated in hepatitis B‐related acute‐on‐chronic liver failure and associated with severity of liver disease

Huang

et al. 2011

Journal of Viral Hepatitis

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“…In China and most other Asian countries, hepatitis B virus (HBV)-associated ACLF (HBV-ACLF) patients account for more than 50% of ACLF patients, owing to a high prevalence of chronic HBV infection3. Though nucleos(t)ide analog therapy, bioartificial liver support systems and stem cell transplantation have been investigated in HBV-ACLF, the long-term survival of HBV-ACLF is still not improved significantly over the past few decades, because majority of them were diagnosed in the very late stages and missed the best treatment time45. Thus, this is a urgent need to establish sensitive and specific bio-markers for early warning and prediction of HBV-ACLF progression, and the latter is critical for timely identifying high-risk patients and making appropriate treatment strategies678.…”

mentioning

confidence: 99%

Plasma Apolipoprotein A-V Predicts Long-term Survival in Chronic Hepatitis B Patients with Acute-on-Chronic Liver Failure

Chen

Zhang

Shi

et al. 2017

Sci Rep

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Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a life-threatening condition, and the lipid metabolism disorder is common in the development of this disease. This prospective observational study aimed to define the characteristics of plasma apolipoprotein A-V (apoA-V) in long-term outcome prediction of HBV-ACLF, and a total of 330 HBV-ACLF patients were included and followed for more than 12 months. In this cohort, the 4-week, 12-week, 24-week and 48-week cumulative mortality of HBV-ACLF was 18.2%(60/330), 50.9%(168/330), 59.7%(197/330) and 63.3%(209/330), respectively. As compared to survivors, the non-survivors had significantly lower concentrations of plasma apoA-V on admission. Plasma apoA-V concentrations were positively correlated with prothrombin time activity (PTA), and negatively correlated with interleukin-10, tumor necrosis factor-α, and iMELD scores. Though plasma apoA-V, PTA, total bilirubin(TBil) and blood urea nitrogen(BUN) were all independent factors to predict one-year outcomes of HBV-ACLF, plasma apoA-V had the highest prediction accuracy. And its optimal cutoff value for one-year survival prediction was 480.00 ng/mL, which had a positive predictive value of 84.68% and a negative predictive value of 92.23%. In summary, plasma apoA-V decreases significantly in non-survivors of HBV-ACLF, and it may be regarded as a new predictive marker for the prognosis of patients with HBV-ACLF.

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“…In high HBV prevalence areas, ACHBLF accounts for more than 70% of acute-on-chronic liver failure cases, and contributes to 120,000 deaths annually [3]. Multiple factors including host immune response, HBV itself, and genetic and epigenetic alterations have been demonstrated to participate in the pathogenesis of ACHBLF [4][5][6][7]. However, the exact mechanism underlying the occurrence of ACHBLF has not been completely demonstrated.…”

Section: Introductionmentioning

confidence: 99%

Expression of Human Glucocorticoid Receptor in T Lymphocytes in Acute-on-Chronic Hepatitis B Liver Failure

et al. 2011

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Antiviral Therapy for Acute-on-Chronic Liver Failure in Chronic Hepatitis B: Is It Too Late?

Cited by 6 publications

References 22 publications

Interleukin‐21 is upregulated in hepatitis B‐related acute‐on‐chronic liver failure and associated with severity of liver disease

Interleukin‐21 is upregulated in hepatitis B‐related acute‐on‐chronic liver failure and associated with severity of liver disease

Plasma Apolipoprotein A-V Predicts Long-term Survival in Chronic Hepatitis B Patients with Acute-on-Chronic Liver Failure

Expression of Human Glucocorticoid Receptor in T Lymphocytes in Acute-on-Chronic Hepatitis B Liver Failure

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