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Background: Acute-on-chronic liver failure (ACLF) has high short-term mortality and lacks sufficient medical therapy. Available algorithms are unable to precisely predict short-term outcomes or safely stratify patients with ACLF as emergent liver transplantation candidates. Therefore, a personalized prognostic tool is urgently needed. Purpose: Platelet function and its clinical significance in ACLF patients with chronic hepatitis B virus (HBV) infection have not been investigated. This study aimed to assess changes in platelet function using thromboelastography (TEG) and platelet mapping (TEG-PM) in HBV-related ACLF patients. Methods: Chronic liver disease patients with acute decompensation or acute hepatic injury were recruited. The derivation cohort enrolled HBV-related patients at Nanfang Hospital. HBV-related and non-HBV-related patients were both enrolled in internal and external validation cohorts at seven university hospitals. TEG and TEG-PM were performed at baseline in the derivation cohort and baseline, day 7, and day 14 in the validation cohorts. The primary outcome was all-cause 28-day mortality. Status check and new-onset complications were recorded during the 3-month follow-up, but status check will extend to 5 years. Conclusion and Future Plans: In this study, 586 participants were enrolled, including 100 in derivation cohort, 133 in internal validation cohort, and 353 in external validation cohort. Biomaterials, including plasma, serum, urine, and some explanted liver tissues, were collected from these patients. A 3-month follow-up with survival status was completed. The baseline characteristics indicated that 51% of the patients had adenosine diphosphate (ADP)-hyporesponsive circulating platelets. The prognostic potential of platelet function will be explored in the derivation cohort (HBV-related ACLF patients) and further substantiated in the validation cohorts (HBV-related and non-HBV-related ACLF patients). Biosamples are currently used to explore the underlying mechanisms related to ADP-hyporesponsive platelets. The ongoing proteomic and metabolic analyses will provide new insights into the pathogenesis of extrahepatic organ failures in ACLF patients. [ABSTRACT FROM AUTHOR]

Background and Aim: Tri‐typing of acute‐on‐chronic liver failure (ACLF), as proposed by the World Gastroenterology Organization (WGO), has not been validated in patients infected with hepatitis B virus (HBV). We aim to compare the three types of ACLF patients in clinic characteristics. Methods: Hospitalized ACLF patients with chronic hepatitis B from five hepatology centers were retrospectively selected and grouped according to the WGO classification. For each group, we investigated laboratory tests, precipitating events, organ failure, and clinical outcome. Results: Compared with type‐B (n = 262, compensated cirrhosis) and type‐C (n = 129, decompensated cirrhosis) ACLF, type‐A patients (n = 195, non‐cirrhosis) were associated with a younger age, the highest platelet counts, the highest aminotransferase levels, and the most active HBV replications. HBV reactivation were more predominant in type‐A, while bacterial infections in type‐B and type‐C ACLF cases. Liver failure (97.4%) and coagulation failure (86.7%) were most common in type‐A compared with type‐B or type‐C ACLF patients. Kidney failure was predominantly identified in type‐C subjects (41.9%) and was highest (23/38, 60.5%) in grade 1 ACLF patients. Furthermore, type‐C ACLF showed the highest 28‐day (65.2%) and 90‐day (75.3%) mortalities, compared with type‐A (48.7% and 54.4%, respectively) and type‐B (48.4% and 62.8%, respectively) ACLF cases. Compared with type‐A (11.7%) ACLF patients, the increased mortality from 28 to 90 days was higher in type‐B (31.6%) and type‐C (37.5%). Conclusion: Tri‐typing of HBV‐related ACLF in accordance with the WGO definition was able to distinguish clinical characteristics, including precipitating events, organ failure, and short‐term prognosis in ACLF patients. [ABSTRACT FROM AUTHOR]

Background & Aims: Current guidelines on the management of bacterascites are limited. This multicentre, retrospective study investigated the clinical features and outcomes of cirrhosis patients with bacterascites. Methods: Two series of cirrhosis patients were evaluated. The first included 418 patients with ascites‐positive cultures at 11 hospitals during 2012‐2018. Clinical characteristics and outcomes were recorded. The second included 208 patients with sterile ascites from a prospective cohort (NCT02457637). Clinical features and outcomes of cirrhotic patients with or without bacterascites were investigated. Results: In the first series, bacterascites was diagnosed in 254/418 (60.8%) patients, and culture‐positive spontaneous bacterial peritonitis (SBP) in 164/418 (39.2%) patients. Gram‐positive bacteria were more prevalent in bacterascites patients than in culture‐positive SBP patients (59.1% vs 22.0%; P <.001). For patients with acute‐on‐chronic liver failure (ACLF) in bacterascites and culture‐positive SBP groups, the 28‐day transplant‐free mortality (41.3% vs 65.5%; P =.015) and the prevalence of in‐hospital acute kidney injury (AKI) (84.8% vs 75%; P =.224). For patients without ACLF in the bacterascites (n = 208) and culture‐positive SBP groups (n = 108), the 28‐day transplant‐free mortalities were 13% vs 13.9% (P =.822), the probabilities of progression to ACLF within 28 days were 10.1% vs 14.8% (P =.216) and the prevalences of in‐hospital AKI were 14.4% vs 30.6% (P =.001). Bacterascites patients had higher 28‐day mortality than those patients with sterile ascites, after propensity score matching (18.4% vs 8.6%; P =.010). Conclusion: Bacterascites patients had non‐negligible poor clinical outcomes, including in‐hospital AKI, progression to ACLF and 28‐day mortality. Future studies are warranted to expedite the diagnosis of bacterascites and optimize antibiotic treatment. [ABSTRACT FROM AUTHOR]

Definitions and descriptions of acute-on-chronic liver failure (ACLF) vary between Western and Eastern types, and alcoholism and hepatitis B virus (HBV) are, respectively, the main etiologies. To determine whether there are unified diagnostic criteria and common treatment programs for different etiologies of ACLF, a multicenter prospective cohort with the same inclusion criteria and disease indicators as those used in the European Consortium Acute-on-Chronic Liver Failure in Cirrhosis Study is urgently needed in Asia, where the prevalence of HBV is high. A multicenter prospective cohort of 2,600 patients was designed, drawing from 14 nationwide liver centers from tertiary university hospitals in China, and 2,600 hospitalized patients with chronic liver disease (both cirrhotic and noncirrhotic) of various etiologies with acute decompensation or acute hepatic injury were continuously recruited from January 2015 to December 2016. Data were collected during hospitalization, and follow-ups were performed once a month, with plans to follow all patients until 36 months after hospital discharge. Of these patients, 1,859 (71.5%) had HBV-related disease, 1,833 had cirrhotic disease, and 767 had noncirrhotic disease. The numbers and proportions of enrolled patients from each participating center and the baseline characteristics of the patients with or without cirrhosis are presented. [ABSTRACT FROM AUTHOR]

Keywords: Hepatitis B virus; Acute-on-chronic liver failure; Prognosis EN Hepatitis B virus Acute-on-chronic liver failure Prognosis 479 480 2 12/30/20 20210201 NES 210201 To the Editor: We read the paper "The PREDICT study uncovers three clinical courses in acutely decompensated cirrhosis with distinct pathophysiology" published in Journal of Hepatology with great interest.[1] This multicenter study reported on 3 different clinical courses with distinct pathophysiology and prognosis in patients with acute decompensation (AD) of cirrhosis. Clinical and laboratory characteristics of the pre-ACLF patients (n = 90), ACLF patients at the time of admission (n = 189) and patients with AD without ACLF development (n = 587) were compared in Table 1. The prevalence of HBV reactivation was different (p <0.001) among these patients and higher in pre-ACLF patients (56.7%) and ACLF patients (57.7%). [Extracted from the article]