Nucleoside Analogues Improve Short-Term Prognosis Of Hbv-Related Acute-On-Chronic Liver Failure But As Not An Independent Risk Factor

Aim: To evaluate the effects of nucleoside analogue (NAs) treatment in improving short-term prognosis of patients with HBV-related acute-on-chronic liver failure (ACLF) and to investigate factors predicting mortality. Methods: In 132 patients hospitalized with HBV-related ACLF, 35 patients were in NAs treatment (NAs group) while 97 patients received NAs after admission (late NAs group). All patients were followed up for 12 months. Child-Turcotte-Pugh (CTP), a model for end-stage liver disease (MELD), and MELD-Na scores with other characteristics and short-term mortality were evaluated. Logisitic regression, COX regression, and Kaplan-Meier analysis were used to determine independent predictors of short-term mortality and overall survival. ROC analysis was used to validate diagnostic power of score systems and their simplification and combination with significant indexes. Results: NAs group showed lower creatinine and higher serum sodium levels, with decreased rates of cirrhosis, gastrointestinal bleeding, and general complications. Mortality in the NAs group was lower at each time point (P < 0.001). Logistic regression showed that only NAs treatment was an independent risk factor within 180 days and 1 year. PT was an independent risk factor for overall survival, with only a slight influence. According to ROC analysis, MELD-Na performed better than CTP and MELD scores. Binary transformation of the MELD-Na score in a cut-off value of 26 with combination of NAs treatment showed familiar diagnostic power with MELD-Na scores. Conclusion: NAs improved short-term survival in HBV-related ACLF. NAs treatment might not be an independent factor to predict short-term mortality within 90 days. MELD-Na scores have superior diagnostic power, while binary transformation combination performed closely.