Analysis of prognostic factors for 24-month survival of hepatitis B virus-associated acute-on-chronic liver failure patients treated with telbivudine

Objective To investigate the baseline independent prognostic factors for 24 months survival of hepatitis B virus (HBV)-associated acute-on-chronic liver failure (ACLF) patients treated with telbivudine. Methods The prospective cohort study was conducted in HBV-associated ACLF patients who were hospitalized in Mengchao Hepatobiliary Hospital of Fujian Medical University and volunteered to be treated with telbivudine for more than 24 months. The patients were observed for survival at month 1, 3, 6, 12, and 24 after treatment. The baseline biochemical index, coagulant function, model for end-stage liver disease (MELD) score, HBV DNA level as well as comorbidities were analyzed in this study. The count data were compared with kappa test or Fisher′s exact test. For the normal distributed measurement data, the homogeneity test of variances (Levene test) was firstly used for comparison between groups. Further, the group t test was applied for variance homogeneity, while the approximate t test was applied for variance non-homogeneity and the Mann-Whitney U test was applied for the non-distributed measurement data. Results A total of 41 patients were enrolled, including 3 drop-outs and 38 accomplishments. Among these 38 patients, there were 3 females (7.9%) and 35 males (92.1%), with ages (38.5±11.1) years. There were 32 patients alive and 6 dead during 1 month′s follow-up, while baseline MELD score was the independent prognostic factor (RR=1.864, 95%CI: 1.151-3.019) for survival. There were 31 patients alive and 7 dead during 3 months′ follow-up, while baseline MELD score and upper gastrointestinal hemorrhage (UGH) were the independent prognostic factors (RR=2.053, 95%CI: 1.163-3.625; RR=394.939, 95%CI: 1.880-82 948.817). There were both 26 patients alive and 12 dead during 6 and 12 months′ follow-up, while baseline MELD score was the independent prognostic factor (RR=1.761, 95% CI: 1.230-2.523). At the end of 24 months′ follow-up, there were 15 patients alive and 23 dead. Viral rebounds were observed in 6 patients and 3 of them were dead. Baseline HBV DNA level, MELD score and electrolyte imbalance were the independent prognostic factors (RR=9.722, 95% CI: 1.607-58.821; RR=1.518, 95% CI: 1.066-2.162; RR=87.505, 95% CI: 2.263-3 384.232) for 24 months′survival. Conclusions Although telbivudine is not recommended as the first-line treatment, ACLF patients with low MELD score and low HBV DNA level at baseline, individualized treatment may improve patient's survival rate. UGH and electrolyte imbalance may affect the efficacy of telbivudine and reduce the survival rate of ACLF patient. Key words: Hepatitis B virus; Liver failure; Telbivudine; Survival analysis