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Background and Aims: Chronic hepatitis B virus (HBV) infection is a major global health issue, and the prognosis of patients with HBV-associated acute-on-chronic hepatic failure (ACLF) is extremely poor. In this study, the efficacy of lamivudine was investigated in patients with ACLF. The effects of HBV DNA load and its related factors on the prognosis were also further explored. Methods: A matched retrospective cohort study using data on ACLF patients derived from our hospital database was conducted. One hundred and thirty patients receiving lamivudine were selected into the lamivudine treatment group with another 130 without lamivudine treatment studied as control. They were matched for sex, age and imaging finding with the lamivudine treatment group. All the patients were followed up for 3 months and the survival rates were compared. The influential factors on the mortality were studied by the Cox proportional hazards model. Results: The cumulative survival rates of patients in the lamivudine group were higher than those of the control group (χ2 = 9.50, P = 0.0021). The mortality of patients in the high virus load group (71/95, 74.7%) was higher than that of those in the low virus load group (15/29, 51.7%) (χ2 = 5.536, P = 0.019). For patients with a Model for End-Stage Liver Disease (MELD) score of 20–30 by week 4, the mortality of those with HBV DNA that was undetectable or declined for more than 2 log10 (2/12, 16.7%; 18/40, 45.0%) was lower than that of those with a less than 2 log10 decline (18/23, 78.3%) (χ2 = 10.106, P = 0.001). In the Cox proportional hazards model, for patients with a MELD score of 20–30, treatment method ( P = 0.002), pretreatment HBV DNA load ( P = 0.007) and decline of HBV DNA load during therapy ( P = 0.003) were independent predictors; for those with a MELD score of above 30, MELD score ( P = 0.008) was the only independent predictor. Conclusion: Lamivudine can significantly decrease the 3-month mortality of patients with a MELD score of 20–30, and a low pretreatment viral load and rapid decline of HBV DNA load are good predictors for the outcome of the treatment. [ABSTRACT FROM AUTHOR]

Background and Aim: We used the model for end-stage liver disease (MELD) scoring system to predict the 3-month prognosis of patients with acute-on-chronic liver failure (ACLF) after plasma exchange (PE) and lamivudine treatment, and studied the predictive factors on the prognosis of patients. Methods: A total of 280 patients treated with lamivudine were randomly divided into PE and control groups. The relationship between mortality and influential factors of patients was studied by univariate and multivariate analysis. Results: The mortality (49.4%) of patients in the PE group with a MELD score from 30 to 40 was lower than that (86.1%) of the control group (χ2 = 24.546, P < 0.01). The total bilirubin (TBIL) rebound rate of the dead group was significantly higher than that of the survival group ( P < 0.01). Univariate analysis showed that mortality was significantly related to age ( P = 0.003), treatment method ( P = 0.000), TBIL ( P = 0.010), MELD score ( P = 0.001), international normalised ratio ( P = 0.014), pretreatment HBV-DNA load ( P = 0.000), decline of hepatitis B virus (HBV)–DNA load during therapy ( P = 0.013), encephalopathy ( P = 0.019), and hepatorenal syndrome ( P = 0.026). In multivariate analysis, MELD scores of 30–40, treatment method ( P = 0.003), pretreatment HBV-DNA load ( P = 0.009), decline of HBV-DNA load during therapy ( P = 0.016), and encephalopathy ( P = 0.015) were independent predictors of mortality; for MELD scores above 40, only the MELD score ( P = 0.012) was an independent predictive. Conclusions: PE significantly decreased the mortality of patients with a MELD score of 30–40. For ACLF patients with a MELD score of 30–40, a low viral load pretreatment and quick decline of HBV-DNA load are good predictors for the survival with PE and lamivudine treatment. [ABSTRACT FROM AUTHOR]

Background and Aim: The therapeutic effect of pegylated interferon (peg-IFN)-α-2a combination with ribavirin on patients with chronic hepatitis C virus (HCV) infection is dependent on the rapidity of the virological response. The aim of this study was to investigate the predictive value of rapid virological response (RVR) and early virological response (EVR) on sustained virological response (SVR) in HCV patients treated with peg-IFN-α-2a and ribavirin. Methods: The HCV genotypes of 105 patients with chronic hepatitis C were detected by enzyme-immunoassay. Patients received subcutaneous 180 µg peg-IFN-α-2a once weekly plus daily ribavirin. Patients with genotype 1 were treated for 48 weeks and patients with genotype 2 or 3 were treated for 24 weeks. HCV RNA was assessed by qualitative PCR at pretreatment, at weeks 4 and 12 during treatment, and at week 24 of follow-up. Virological response rates at different weeks were investigated, with RVR defined as serum HCV RNA undetectable after 4 weeks and EVR defined as HCV RNA either undetectable or decrease by ≥2 log10 after 12 weeks. The effects of virological response rates at different weeks on SVR were analyzed. Results: Of the 105 patients, 44 (41.9%) were genotype 1, 46 (43.8%) were genotype 2, and 15 (14.3%) were genotype 3. RVR rates (19.5%) of patients with genotype 1 were significantly lower than those (60.7%) of genotype 2 or 3 (χ2 = 16.836, P = 0.000); and EVR rates (73.2%) of patients with genotype 1 were significantly lower than those (96.7%) of genotype 2 or 3 (χ2 = 12.220, P = 0.000). The SVR rates (86.7%) of patients who had achieved RVR were significantly higher than those (43.9%) of patients who had not achieved RVR (χ2 = 19.713, P = 0.000). The positive predictive value of RVR in all patients was higher than that of EVR, but there was no significant difference between RVR and EVR. The negative predictive value of RVR in all patients or with genotype 1 was significantly lower than that of EVR. In univariate analysis, HCV RNA level ( P = 0.014), genotype ( P = 0.001), RVR ( P = 0.000) and EVR ( P = 0.000) were associated with effect of treatment. However, in stepwise regression analysis, the independent factors associated with effect of antiviral therapy were RVR (OR = 6.501, P = 0.001), EVR (OR = 2.776, P = 0.003) and genotype (OR = 3.061, P = 0.024). Conclusions: The RVR and EVR rates of patients with genotype 1 were significantly lower than those of patients with genotype 2 or 3. RVR had a similar predictive value as EVR on SVR. Genotype, HCV RNA level, RVR and EVR were associated with SVR. Genotype, RVR and EVR were independent factors for predicting the effect of antiviral therapy. [ABSTRACT FROM AUTHOR]

Aim: To predict prognosis in patients with acute-on-chronic hepatitis (AOCH) using the model for end-stage liver disease (MELD) scoring system and to study the effects of age, sex, etiology, low serum sodium, and persistent ascites on MELD. Methods: The MELD scores of 300 patients with AOCH were calculated according to the original formula. The 3-month mortality in patients was measured, and the validity of the models was determined by means of the concordance ( c) statistic. The influential factors on MELD were also assessed. Results: The 3-month mortality of AOCH patients with a MELD score of 20–29 was 56.0%, with a score of 30–39 it was 76.5%, and with a score over 40 it was 98.2%. The concordance ( c) statistic of 3-month mortality was 0.782. Univariate analysis showed that mortality was significantly related to age ( P = 0.047), etiology ( P = 0.039), serum sodium ( P = 0.029) and ascites ( P = 0.031) for patients with MELD scores 20–29. In multivariate analysis, in patients with MELD scores 20–29, age ( P = 0.012), etiology ( P = 0.024), serum sodium ( P = 0.005) and ascites ( P = 0.017) were independent predictors of mortality; for MELD scores above 30, only MELD score ( P = 0.015) was independently predictive. Conclusions: The MELD scoring system is a reliable method for predicting mortality in patients with AOCH. In the group with MELD score 20–29, factors including age, etiology, presence of low serum sodium and persistent ascites may influence the MELD scoring system. The MELD score is the decisive predictor of the prognosis of patients with AOCH when the MELD score is over 30. [ABSTRACT FROM AUTHOR]