Experiments: CG CB CR. Performed the experiments: KA CN MK. Analyzed the data: KA CN MK. Wrote the paper: KA. Reviewed the manuscript: AS CR. Performed DST: KB.
Hepatitis B virus (HBV) infection is the most common cause of liver disease worldwide [1]. Approximately 400 million people are suffering from chronic hepatitis B (CHB) infection and may develop complications like cirrhosis, and hepatocellular carcinoma (HCC) [2]. Acute on chronic liver failure (ACLF) is an acute hepatic insult in patients who have chronic liver disease, manifesting as jaundice (serum bilirubin.5 mg/dl or 85 mol/L) and coagulopathy (INR.1.5 or prothrombin activity,40 ), often complicated by ascites and/or encephalopathy within 4 weeks of the acute presentation [3]. The underlying chronic liver diseases in ACLF vary depending on the geographic region. Alcoholic hepatitis is common in western countries, whereas chronichepatitis B or C infections are often seen in Asian countries. The common participating factors include viral hepatitis reactivation, alcohol, hepatotoxic drugs/herbs. In acute on chronic hepatitis B liver failure (ACHBLF), HBV reactivation is the major acute insults and precipitation liver failure [3]. It may occur after withdrawal of HBV antiviral treatment but more often, due to non- HBV treatment related events, which include disease reactivation either spontaneous or secondary to intensive chemotherapy/immunosuppressive therapy. Liver transplantation is the only curative therapeutic option for ACHBLF with a 5-year survival rate of 85 [4,5]. However, infectious complications often preclude transplant in patients with ACHBLF and many die on the waiting list due to the shortage of organs [6]. In 2008, the localDynamic Changes of LPS in ACLF with HBVstandard of care for ACHBLF other than transplantation for ACHBLF was supportive care. Prior to the time we concluded this study, there was no Title Loaded From File prospective randomized control trial to support the effectiveness and safety use of antiviral therapy in patients with ACHBLF [7]. In addition, Lange et al reported that a significant portion of patients with high MELD scores and treated with entecavir developed lactic acidosis resulting in high mortality [8]. Thus, the local standard of care at that time required a detailed discussion with patients and obtaining the consent prior to the antiviral use in patients with ACHBLF. Due to the lacking of evidence on the use of antiviral for ACHBLF during our study period, two patterns of clinical practice were observed in our center: patients who believed the potential benefit of antiviral treatment were treated with nucleoside (tenofovir was not available in China), whereas, patients who believed that the antiviral had no role on hepatic regeneration during acute setting or unwilling to take the risk of lactic acidosis could defer the antiviral treatment until they recovered from the acute event, and then received antiviral treatment for CHB when their disease severity was improved (low MELD scores had less Title Loaded From File frequency of lactic acidosis). Our study was designed to capture those patients who deferred antiviral treatment but were able to recover spontaneously from ACHBLF without intervention. The mechanism of ACHBLF remains unclear. It was speculated that pro-inflammatory cytokines mediated hepatic inflammation along with oxidative stress and the production of nitric oxide initiated the acute hepatic injury, 1662274 followed by neutrophil dysfunction from circulating endotoxins (t.Experiments: CG CB CR. Performed the experiments: KA CN MK. Analyzed the data: KA CN MK. Wrote the paper: KA. Reviewed the manuscript: AS CR. Performed DST: KB.
Hepatitis B virus (HBV) infection is the most common cause of liver disease worldwide [1]. Approximately 400 million people are suffering from chronic hepatitis B (CHB) infection and may develop complications like cirrhosis, and hepatocellular carcinoma (HCC) [2]. Acute on chronic liver failure (ACLF) is an acute hepatic insult in patients who have chronic liver disease, manifesting as jaundice (serum bilirubin.5 mg/dl or 85 mol/L) and coagulopathy (INR.1.5 or prothrombin activity,40 ), often complicated by ascites and/or encephalopathy within 4 weeks of the acute presentation [3]. The underlying chronic liver diseases in ACLF vary depending on the geographic region. Alcoholic hepatitis is common in western countries, whereas chronichepatitis B or C infections are often seen in Asian countries. The common participating factors include viral hepatitis reactivation, alcohol, hepatotoxic drugs/herbs. In acute on chronic hepatitis B liver failure (ACHBLF), HBV reactivation is the major acute insults and precipitation liver failure [3]. It may occur after withdrawal of HBV antiviral treatment but more often, due to non- HBV treatment related events, which include disease reactivation either spontaneous or secondary to intensive chemotherapy/immunosuppressive therapy. Liver transplantation is the only curative therapeutic option for ACHBLF with a 5-year survival rate of 85 [4,5]. However, infectious complications often preclude transplant in patients with ACHBLF and many die on the waiting list due to the shortage of organs [6]. In 2008, the localDynamic Changes of LPS in ACLF with HBVstandard of care for ACHBLF other than transplantation for ACHBLF was supportive care. Prior to the time we concluded this study, there was no prospective randomized control trial to support the effectiveness and safety use of antiviral therapy in patients with ACHBLF [7]. In addition, Lange et al reported that a significant portion of patients with high MELD scores and treated with entecavir developed lactic acidosis resulting in high mortality [8]. Thus, the local standard of care at that time required a detailed discussion with patients and obtaining the consent prior to the antiviral use in patients with ACHBLF. Due to the lacking of evidence on the use of antiviral for ACHBLF during our study period, two patterns of clinical practice were observed in our center: patients who believed the potential benefit of antiviral treatment were treated with nucleoside (tenofovir was not available in China), whereas, patients who believed that the antiviral had no role on hepatic regeneration during acute setting or unwilling to take the risk of lactic acidosis could defer the antiviral treatment until they recovered from the acute event, and then received antiviral treatment for CHB when their disease severity was improved (low MELD scores had less frequency of lactic acidosis). Our study was designed to capture those patients who deferred antiviral treatment but were able to recover spontaneously from ACHBLF without intervention. The mechanism of ACHBLF remains unclear. It was speculated that pro-inflammatory cytokines mediated hepatic inflammation along with oxidative stress and the production of nitric oxide initiated the acute hepatic injury, 1662274 followed by neutrophil dysfunction from circulating endotoxins (t.
