TABLE 2.
Baseline characteristics of patients with Hepatitis B associated acute liver failure.
| HBV-associated ALF due to Immunosuppression (N = 28) | Controls (N = 128) | P | |||
|---|---|---|---|---|---|
| N | N (%) or median (IQR) | N | N (%) or median (IQR) | ||
| Age | 28 | 51.5 (40.0–60.0) | 128 | 41.0 (30.5–53.0) | 0.0014 |
| Sex (female) | 28 | 12 (42.9%) | 128 | 62 (48.4%) | 0.59 |
| Race | 28 | 128 | 0.0001 | ||
| White | 10 (35.7%) | 73 (57.0%) | |||
| African-american | 4 (14.3%) | 37 (28.9%) | |||
| Other | 14 (50.0%) | 18 (14.1%) | |||
| Blood biochemistry (admission) | |||||
| Hemoglobin (g/dL) | 27 | 11.0 (9.8–12.4) | 124 | 12.1 (10.8–13.6) | 0.019 |
| White blood cells (109/L) | 27 | 7.6 (5.4–12.3) | 124 | 9.3 (7.1–12.3) | 0.14 |
| Platelets (109/L) | 26 | 117.5 (70.0–152.0) | 122 | 165.0 (125.0–226.0) | <0.0001 |
| INR | 27 | 3.2 (2.4–6.1) | 121 | 2.8 (2.1–5.3) | 0.37 |
| Bilirubin (mg/dL) | 27 | 19.2 (13.4–22.9) | 125 | 18.4 (10.4–25.2) | 0.80 |
| ALT (IU/L) | 26 | 1852.0 (701.0–2926.0) | 125 | 1671.0 (670.0–3244.0) | 0.95 |
| Creatinine (mg/dL) | 27 | 0.9 (0.6–1.1) | 126 | 1.1 (0.7–2.0) | 0.059 |
| Lactate (mmol/L) | 10 | 3.6 (2.3–5.2) | 43 | 4.6 (2.6–6.3) | 0.39 |
| MELD (admission) | 27 | 34.0 (28.6–43.9) | 118 | 34.5 (28.1–42.7) | 0.94 |
| Hepatic encephalopathy* (first 7 days) | |||||
| Grade III/IV | 20 | 14 (60.0%) | 106 | 70 (66.0%) | 0.92 |
| King’s College criteria** (admission) | 27 | 9 (33.3%) | 121 | 43 (35.5%) | 0.83 |
| Organ support (first 7 days) | |||||
| Mechanical ventilation | 28 | 12 (42.9%) | 128 | 66 (51.6%) | 0.40 |
| Vasopressors | 28 | 8 (28.6%) | 128 | 29 (22.7%) | 0.51 |
| Renal replacement therapy | 28 | 6 (21.4%) | 128 | 18 (14.1%) | 0.33 |
| Hepatitis B serology (admission) | |||||
| Positive HBsAg | 28 | 24 (85.7%) | 127 | 108 (85.0%) | 0.17 |
| Prior positive HbsAg | 14 | 9 (64.3%) | 39 | 6 (15.4%) | 0.0005 |
| Positive Anti-HBc (total) | 28 | 24 (85.7%) | 128 | 123 (96.1%) | 0.055 |
| Positive Anti-HBc (IgM) | 28 | 12 (42.9%) | 125 | 107 (85.6%) | <0.0001 |
| Positive Anti-HBs | 27 | 6 (22.2%) | 128 | 37 (28.9%) | 0.12 |
| Positive HBV-DNA | 26 | 18 (69.2%) | 122 | 78 (63.9%) | 0.82 |
| HBV-DNA (copies/mL) | 10 | 188704 (61075–116569367) | 28 | 110020 (307–1059273) | 0.35 |
| Positive Anti-HDV | 28 | 1 (3.6%) | 123 | 1 (0.8%) | 0.48 |
| Nucleoside therapy (admission) | 28 | 12 (43%) | 128 | 36 (28%) | 0.17 |
| Lamivudine | 5 | 29 | |||
| Entecavir | 2 | 5 | |||
| Tenofovir | 5 | 2 | |||
| Adefovir | 0 | 2 | |||
| N-acetyl-cysteine (first 7 days) | 28 | 7 (25.0%) | 128 | 39 (30.5%) | 0.57 |
| ICP therapies (first 7 days) | |||||
| ICP monitor | 26 | 1 (3.9%) | 119 | 13 (10.9%) | 0.27 |
| Mannitol | 28 | 2 (7.1%) | 128 | 17 (13.3%) | 0.37 |
| Hypertonic saline | 28 | 0 (0.0%) | 128 | 6 (4.7%) | 0.24 |
| Hypothermia | 28 | 0 (0.0%) | 128 | 3 (2.3%) | 0.41 |
| Complications (first 7 days) | |||||
| Seizures | 28 | 0 (0.0%) | 128 | 2 (1.6%) | 0.50 |
| Gastro-intestinal bleeding | 28 | 1 (3.6%) | 128 | 7 (5.5%) | 0.68 |
| Blood infection | 28 | 1 (3.6%) | 128 | 7 (5.5%) | 0.68 |
| Outcomes (first 21 days) | |||||
| Waitlisted for transplant | 26 | 11 (42.3%) | 127 | 60 (47.2%) | 0.65 |
| Transplanted | 28 | 7 (25.0%) | 128 | 45 (35.2%) | 0.40 |
| Overall survival | 28 | 12 (42.9%) | 128 | 80 (62.5%) | 0.0096 |
| Spontaneous survival | 28 | 6 (21.4%) | 121 | 46 (38.0%) | 0.097 |
| Cause of death*** | 16 | 31 | 0.85 | ||
| Hepatic failure | 6 (37.5%) | 9 (29.0%) | |||
| Multiorgan failure | 7 (43.8%) | 11 (35.5%) | |||
| Septic shock | 1 (6.3%) | 4 (12.9%) | |||
| Neurological event | 2 (12.5%) | 5 (16.1%) | |||
| Intraoperative | 0 (0.0%) | 1 (3.2%) | |||
| Cardiac event | 0 (0.0%) | 1 (3.2%) |
N: frequency. IQR: interquartile range. INR: international normalized ratio. AST: aspartate aminotransferase. ALT: alanine aminotransferase. MELD: Model for End-stage Liver Disease. HBsAg: hepatitis B virus surface antigen. Anti-HBc: hepatitis B virus core antibody. Anti-HBs: hepatitis B virus surface antibody. HBV-DNA: hepatitis B virus deoxyribonucleic acid. Anti-HDV: hepatitis D virus antibody. ICP: intracranial pressure.
Hepatic encephalopathy evaluated according to West-Haven criteria.
King’s College criteria for non-acetaminophen acute liver failure [10].
n=16 deaths in the IMX-HBV-ALF group and n=48 in the control group. Causes of death in 17 control patients were unavailable.