Journal of Clinical Hepatology
This article prospectively analyzes the prognostic scores and dynamic changes of key clinical indicators in 154 patients with non-cirrhotic HBV-related chronic-onset acute liver failure (HBV-ACLF) during the 1st to 28th day of the disease course. According to the 1-year outcome, the patients are divided into death/liver transplantation group, cirrhosis group, and non-cirrhosis group, and the differences in longitudinal trajectories of patients with different outcomes are discussed. The study found that the death or liver transplantation group showed a continuous increase in TBil and INR (>400 μmol/L, >2.5), and a decrease in PLT below 100×10⁹/L, while the patients who survived and did not progress to cirrhosis showed rapid improvement in indicators; the cirrhosis group showed a recovery trend, but still had TBil>200 μmol/L, INR>1.5, and PLT<100×10⁹/L at 28 days. The innovation lies in the first systematic depiction of the dynamic evolution trajectory of non-cirrhotic HBV-ACLF patients with different prognoses, breaking through the limitations of traditional single-time point evaluation, using linear mixed-effects models to analyze the interaction between time and groups, and revealing the change patterns of key indicators within 28 days can effectively predict long-term outcomes. In addition, the study emphasizes the importance of dynamic monitoring of MELD, CLIF-C ACLF and other scores, as well as indicators such as TBil, INR, PLT, AFP, and blood sodium for individualized prognostic evaluation and clinical intervention, providing a basis for the subsequent establishment of dynamic risk stratification models.
This study focuses on the prognostic evaluation of patients with HBV-related chronic-onset acute liver failure (HBV-ACLF) under the background of non-cirrhosis, which has important clinical significance. By longitudinally analyzing the dynamic changes of dynamic indicators in different outcome groups (death/liver transplantation, progression to cirrhosis, non-cirrhosis recovery) within one year, the differences in the evolution trajectory of TBil, INR, PLT, and various prognostic scores (MELD, CLIF-C ACLF, etc.) at different time points are revealed. The study found that the death or liver transplantation group showed a continuous increase in TBil >400 μmol/L, INR >2.5, and PLT <100×10⁹/L, indicating that severe liver dysfunction is closely related to poor prognosis; while the indicators of the non-cirrhosis recovery group improved rapidly, and the progression to cirrhosis group showed moderate and persistent abnormalities. This result emphasizes that dynamic monitoring is superior to single testing, which can identify high-risk patients earlier and achieve individualized intervention. In addition, the study fills the gap in existing models that pay more attention to short-term prognosis while ignoring the long-term progression of liver fibrosis, providing a scientific basis for formulating follow-up strategies and intervention timing. Ultimately, the construction of a prognostic evaluation system based on dynamic trends helps to optimize clinical decision-making and improve the quality of life of patients.
Objective: To investigate the dynamic trajectories of prognostic scores and key clinical indicators in hepatitis B virus-related acut…
