Characteristics, Diagnosis and Prognosis of Acute-on-Chronic Liver. Failure in Cirrhosis Associated to Hepatitis B.
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1 Supplementary Appendix Characteristics, Diagnosis and Prognosis of Acute-on-Chronic Liver Failure in Cirrhosis Associated to Hepatitis B. Hai Li, Liu-Ying Chen, Nan-nan Zhang, Shu-Ting Li, Bo Zeng, Marco Pavesi, Àlex Navarro, Rajeshwar P Mookerjee, Qian Xia, Feng Xue, Xiong Ma, Jing Hua, Li Sheng, De-kai Qiu, Qing Xie, Graham R Foster, Geoffrey Dusheiko, Richard Moreau, Pere Gines, Vicente Arroyo, Rajiv Jalan. 1
2 Table of Contents Table/Figure Title Page Supplementary Table S1 Supplementary Table S2 Supplementary Table S3 Supplementary Figure S1 Characteristics of Patients at hospital admission. Characteristics and prognosis of patients with ACLF with and without prior history of AD. Clinical characteristics and mortality according to the presence/absence or type of precipitating events in patients with ACLF The CLIF-Organ Failure score system
3 Supplementary Table S1. Characteristics of Patients at hospital admission. Age(y) 50.0±11.2 Male sex 683(76.7) Cause of cirrhosis HBValone 807(90.7) HBV+Alcohol 55(6.2) HBV+other hepatitis virus 17(1.9) HBV+schistosomiasis 11(1.2) HBV-DNA level(iu/ml) (17.6) >100-2x (48.9) >2x10 4-2x (27.4) >2x (6.1) Treatment with NUCs* 209(23.5) Cause of hospitalization at enrolment Ascites 506(56.9) Hepatic Encephalopathy 103(11.8) Bacterial infections 40(4.4) GI-bleeding 237(26.5) Other cause 4(0.4) Potential precipitating events(pe) of ACLF No PE s 402(45.2) At least one PE 389(43.7) >1PE 99(11.1) Bacterial infection 94(10.6) 3
4 Gastrointestinal hemorrhage 67(7.5) Active alcoholism** 64(7.2) HBV reactivation 41(4.6) others 151(16.9) Previous decompensation No 400(44.9) Yes 490(55.1) Site of hospitalization at enrolment Intensive care unit 0(0.0) Ward 890(100.0) Laboratory data Hematocrit(%) 30±7 Platelet count(x 10 9 /L) 78±59 Serum bilirubin(mg/dl) 11.8±14.9 International normalized ratio 2.0±1.2 Alanine aminotransferase(u/l) 156±394 Aspartate aminotransferase(u/l) 139±293 γ-glutamyltransferase(u/l) 64±79 Serum creatinine(mg/dl) 1.0±0.9 Serum sodium(mmol/l) 134±9 Leukocyte count(x10 9 /L) 6.4±4.9 MELD score at enrolment 20.2±9.4 MELD na score at enrolment 22.6±9.3 Liver failure 268(30.1) Kidney failure 89(10.0) Cerebral failure 46(5.2) Coagulation failure 232(26.1) 4
5 Respiration failure 11(1.2) Circulation failure 21(2.4) No organ ailure 510(57.3) 1 organ failure 180(20.2) >1 organ failure 200(22.5) Renal dysfunction 46(5.3) Cerebral dysfunction 74(8.3) ACLF 243(27.3) GradeI 45(5.1) GradeII 132(14.8) GradeIII 66(7.4) Data are mean±standard Deviation or n(%) *within 6months prior to enrolment **within 3 months prior to hospitalization 5
6 Supplementary Table S2. Characteristics and prognosis of patients with ACLF with and without prior history of AD. Characteristics Any prior AD (n=143) No prior AD (n=157) p-value Age(y) 46.9± ± Male sex 102(71.3) 131(83.4) Ascites 110(76.9) 119(76.3) Cause of cirrhosis HBV alone 120(86.3) 143(91.1) HBV+Alcohol 13(9.4) 6(3.8) HBV+other hepatitis virus 4(2.9) 4(2.6) HBV+schistosomiasis 2(1.4) 4(2.6) HBV-DNA level(iu/ml) (18.9) 33(21.0) >100-2x (51.7) 83(52.9) >2x10 4-2x (24.5) 33(21.0) >2x10 6 7(4.9) 8(5.1) Treatment with NUCs* 46(32.2) 49(31.2) Potential precipitating events of ACLF Bacterial infection 31(21.7) 28(18.0) Gastrointestinal haemorrhage 19(13.3) 4(2.6) <0.001 Active alcoholism** 14(9.8) 16(10.2) HBV reactivation 19(13.3) 8(5.1) others 20(14) 20(14) No precipitating events 51(35.7) 84(53.5) At least one precipitating event 71(49.7) 61(38.9) 6
7 >1 precipitating events 21(14.7) 12(7.6) Organ failures Liver 102(72.3) 131(84.5) Kidney 44(31.0) 41(26.5) Cerebral 37(25.9) 34(21.7) Coagulation 91(64.1) 112(72.3) Circulation 35(24.5) 22(14.0) Lungs 21(14.7) 22(11.4) Renal dysfunction 21(15.1) 23(15.1) Cerebral dysfunction 28(19.6) 29(18.5) ACLF GradeI 25(18.1) 20(13.4) GradeII 55( (49.0) GradeIII 31(22.5) 35(22.3) Laboratory data Leukocyte count(x10 9 /L) 10.4± ± Platelet count(x10 9 /L) 81±68 88± Serum bilirubin(mg/dl) 23.6± ± International normalized ratio 3.1± ± Alanine aminotransferase(u/l) 241± ± Aspartate aminotransferase(u/l) 240± ± γ-glutamyltransferase(u/l) 54±54 83± Serum creatinine(mg/dl) 1.6± ± Mortality 28 days 66(46.2) 66(42.0) days 74(51.8) 76(48.4) days 77(53.9) 76(48.4)
8 365 days 78(54.6) 77(49.0) Data are mean±standard Deviation or n(%) *within 6 months prior to enrolment **within 3 months prior to hospitalization 8
9 Supplementary Table S3. Clinical characteristics and mortality according to the presence/absence or type of precipitating events in patients with ACLF Characteristics HBV reactivation Other Precipitating event No Precipitating event but HBV DNA>500 No Precipitating event and HBV DNA 500 p-value N=27 N=81 N=155 N=37 Age(y) 41.5± ± ± ± Male sex 21(77.8) 65(80.3) 117(75.5) 30(81.1) Previous decompensation No 8(29.6) 39(48.2) 87(56.1) 23(62.2) Yes 19(70.4) 42(51.9) 68(43.9) 14(37.8) Ascites 22(81.5) 61(75.3) 136(87.7) 29(78.4) Mean arterial pressure(mmhg) 95±15 85±15 85± ± Organ failures Liver 25(92.6) 51(63.0) 121(78.1) 25(67.6) Kidney 6(22.2) 32(39.5) 41(26.5) 10(27.0) Cerebral 4(14.8) 5(6.2) 22(14.2) 12(32.4) Coagulation 19(70.4) 42(51.9) 90(58.1) 23(62.2) Circulation 2(7.4) 9(11.1) 7(4.5) 1(2.7) Lungs 1(3.7) 3(3.7) 4(2.6) 3(8.1) Renal dysfunction 3(11.5) 13(16.9) 24(15.8) 4(11.1) Cerebral dysfunction 9(33.3) 20(24.7) 24(15.5) 4(10.8) Laboratory data Hematocrit(%) 36±7 29±7 29±8 31± Leucocytes 10.5± ± ± ± Platelet count( 10 9 /L) 86±42 91±74 86±60 86± Serum bilirubin(mg/dl) 28±10 23±17 27±17 20± International normalized ratio 3.3± ± ± ± Alanine aminotransferase(u/l) 508± ± ± ± Aspartate aminotransferase(u/l) 368± ± ± ± γ-glutamyltransferase(u/l) 86±84 83±122 64±81 51± Serum creatinine(mg/dl) 1.6± ± ± ±
10 Serum sodium(mmol/l) 130±7 131±8 129±7 131± ACLF grades: ACLF-I 5(18.5) 17(21.0) 28(18.1) 5(13.5) ACLF-II 16(59.3) 31(38.3) 86(55.5) 14(37.8) ACLF-III 6(22.2) 33(40.7) 41(26.5) 18(48.7) Mortality 28 days 12(44.4) 39(48.2) 56(36.1) 22(59.5) days 13(48.2) 46(56.8) 69(44.5) 23(62.2) days 13(48.2) 47(58.0) 71(45.8) 23(62.2) days 13(48.2) 47(58.0) 73(47.1) 23(62.2) Data are mean±standard Deviation or n(%) 10
11 11
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