Long-Term Prognosis of Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure: A Retrospective Study

Introduction and Objectives: The long-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is not well characterized. We sought to assess the short-term and long-term outcomes and the associated risk factors of HBV-ACLF patients in south China.Patients and Methods: We retrospectively analyzed clinical data, adverse events, and clinical endpoint events of HBV-ACLF patients treated at our department between January 2014 and December 2018. Results: A total of 1177 HBV-ACLF patients were included in the study, including 616 (52.3%) cirrhotic patients and 561 (47.7%) non-cirrhotic patients. 973 (83%) patients were associated only with HBV, and 204 (17%) patients had two or more etiologies. The leading cause of simple HBV-ACLF patients was lack of antiviral treatment and the proportion of patients receiving antiviral treatment for HBV was low (20%). Further analyses indicated non-cirrhotic patients had a significantly lower 90-day transplantation‐free mortality and greater 5‐year survival rate than cirrhotic patients (59.5% vs. 27.6%, 62% vs. 36%, P＜0.05). Age, hepatic encephalopathy, liver cirrhosis, nucleoside (acid) analogues (NAs) withdrawal, total bilirubin, and prothrombin time were independent risk factors for 90-day mortality in HBV-ACLF patients. Cirrhosis at admission (AOR=3.675, 95% CI: 2.408–6.594) was a strong independent risk factor for long-term prognosis. Conclusion: The proportion of HBV-ACLF patients receiving antiviral treatment was extremely low in south China. HBV combined with acute hepatitis E, or DILI had no significant effect on the short-term mortality rate in HBV-ACLF patients. Remarkably, the effect of withdrawal of NAs and cirrhosis on short-term outcomes cannot be ignored. No significant improvement in the short-term prognosis of HBV-ACLF patients was observed compared with previous studies. Trial Registration: The trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT04231565). Registered 13 May 2020https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009OZY&selectaction=Edit&uid=U00036P1&ts=2&cx=27seqt