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KMID : 1040620150210030232
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Clinical and Molecular Hepatology
2015 Volume.21 No. 3 p.232 ~ p.241
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Static and dynamic prognostic factors for hepatitis-B-related acute-on-chronic liver failure
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Ha Jung-Min
Sohn Won
Cho Ju-Yeon
Pyo Jeung-Hui
Choi Kyu
Sinn Dong-Hyun
Gwak Geum-Youn
Choi Moon-Seok
Lee Joon-Hyeok
Koh Kwang-Chul
Paik Seung-Woon
Yoo Byung-Chul
Paik Yong-Han
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Abstract
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Background/Aims: Hepatitis-B-related acute-on-chronic liver failure has a poor prognosis. However, the advent of potent oral antiviral agents means that some patients can now recover with medical treatment. We aimed to identify the prognostic factors for hepatitis-B-related acute-on-chronic liver failure including the initial as well as the dynamically changing clinical parameters during admission.
Methods: Sixty-seven patients were retrospectively enrolled from 2003 to 2012 at Samsung Medical Center. The patients were classified into three categories: Recovery group (n=23), Liver transplantation group (n=28), and Death group (n=16). The Liver transplantation and Death groups were combined into an Unfavorable prognosis group. We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals.
Results: A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (≥28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P =0.012), and the aggravation of hepatic encephalopathy during hospitalization (≥grade III) (OR=15.41, P =0.013). Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P =0.016).
Conclusions: Dynamic changes in clinical parameters during admission are useful prognostic factors for hepatitis-B-related acute-on-chronic liver failure.
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KEYWORD
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Acute-on-chronic liver failure, Chronic hepatitis B, Model for End-Stage Liver Disease, Liver transplantation
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