HBV-Associated Acute Liver Failure After Immunosuppression and Risk of Death

Constantine J. Karvellas, Filipe S. Cardoso, Michelle Gottfried, K. Rajender Reddy, A. James Hanje, Daniel Ganger, William M. Lee

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background & Aims: Acute liver failure (ALF) caused by hepatitis B virus (HBV) infection can occur after immunosuppressive treatment and be fatal, although it might be preventable. We aimed to characterize the causes, clinical course, and short-term outcomes of HBV-associated ALF after immune-suppressive therapy, compared with patients with HBV-associated ALF without immunosuppression (control subjects). Methods: We performed a retrospective multicenter study of 156 consecutive patients diagnosed with HBV-associated ALF (22 with a solid or blood malignancy) enrolled in the Acute Liver Failure Study Group registry from January 1998 through April 2015. We collected data on results of serologic and hepatic biochemistry analyses, grade of hepatic encephalopathy, Model for End-Stage Liver Disease score, and King's College criteria. We also collected data on clinical features, medical therapies, and complications in the first 7 days following study enrollment. Logistic regression was used to identify factors associated with transplant-free survival at 21 days in HBV-associated ALF (the primary outcome). Results: Among patients with HBV-associated ALF, 28 cases (18%) occurred after immunosuppressive therapy (15 patients received systemic corticosteroids and 21 received chemotherapy); and 128 cases did not (control subjects, 82%). Significantly greater proportions of patients with HBV-associated ALF after immunosuppression were nonwhite persons, and had anemia or thrombocytopenic than control subjects (P < .02 for all). The serologic profile of HBV infection, severity of liver failure (based on Model for End-Stage Liver Disease score), and complications (hepatic encephalopathy or need for mechanical ventilation, vasopressors, or renal-replacement therapy) were similar between the groups (P > .17 for all). Significantly smaller proportions of patients with ALF after immunosuppression than control subjects survived for 21 days (42.9% vs 62.5% of control subjects; . P = .0096). Factors associated with 21-day transplant-free survival (C statistic = 0.866) were increased Model for End-Stage Liver Disease score (odds ratio, 0.894 per increment), requirement for mechanical ventilation (odds ratio, 0.111), and immunosuppressive therapy (odds ratio, 0.274). Conclusions: Within a cohort study of patients with HBV-associated ALF, 18% had received immunosuppressive therapy. Significantly smaller proportions of patients with HBV-associated ALF after immunosuppression survive beyond 21 days than patients with HBV-associated ALF who did not receive immunosuppression. Patients undergoing chemotherapy should be screened for HBV infection and given appropriate antiviral therapies to reduce preventable mortality.

Original languageEnglish (US)
JournalClinical Gastroenterology and Hepatology
DOIs
StateAccepted/In press - 2016

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Acute Liver Failure
Hepatitis B virus
Immunosuppression
Immunosuppressive Agents
End Stage Liver Disease
Odds Ratio
Virus Diseases
Therapeutics
Transplants
Drug Therapy
Survival
Hepatic Encephalopathy
Artificial Respiration
Biochemistry
Curriculum
Multicenter Studies
Antiviral Agents
Registries
Anemia
Adrenal Cortex Hormones

Keywords

  • Acute Liver Failure
  • Chemotherapy
  • Hepatitis B
  • Immunosuppression

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

HBV-Associated Acute Liver Failure After Immunosuppression and Risk of Death. / Karvellas, Constantine J.; Cardoso, Filipe S.; Gottfried, Michelle; Reddy, K. Rajender; Hanje, A. James; Ganger, Daniel; Lee, William M.

In: Clinical Gastroenterology and Hepatology, 2016.

Research output: Contribution to journalArticle

Karvellas, Constantine J. ; Cardoso, Filipe S. ; Gottfried, Michelle ; Reddy, K. Rajender ; Hanje, A. James ; Ganger, Daniel ; Lee, William M. / HBV-Associated Acute Liver Failure After Immunosuppression and Risk of Death. In: Clinical Gastroenterology and Hepatology. 2016.
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AU - Karvellas, Constantine J.

AU - Cardoso, Filipe S.

AU - Gottfried, Michelle

AU - Reddy, K. Rajender

AU - Hanje, A. James

AU - Ganger, Daniel

AU - Lee, William M.

PY - 2016

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N2 - Background & Aims: Acute liver failure (ALF) caused by hepatitis B virus (HBV) infection can occur after immunosuppressive treatment and be fatal, although it might be preventable. We aimed to characterize the causes, clinical course, and short-term outcomes of HBV-associated ALF after immune-suppressive therapy, compared with patients with HBV-associated ALF without immunosuppression (control subjects). Methods: We performed a retrospective multicenter study of 156 consecutive patients diagnosed with HBV-associated ALF (22 with a solid or blood malignancy) enrolled in the Acute Liver Failure Study Group registry from January 1998 through April 2015. We collected data on results of serologic and hepatic biochemistry analyses, grade of hepatic encephalopathy, Model for End-Stage Liver Disease score, and King's College criteria. We also collected data on clinical features, medical therapies, and complications in the first 7 days following study enrollment. Logistic regression was used to identify factors associated with transplant-free survival at 21 days in HBV-associated ALF (the primary outcome). Results: Among patients with HBV-associated ALF, 28 cases (18%) occurred after immunosuppressive therapy (15 patients received systemic corticosteroids and 21 received chemotherapy); and 128 cases did not (control subjects, 82%). Significantly greater proportions of patients with HBV-associated ALF after immunosuppression were nonwhite persons, and had anemia or thrombocytopenic than control subjects (P < .02 for all). The serologic profile of HBV infection, severity of liver failure (based on Model for End-Stage Liver Disease score), and complications (hepatic encephalopathy or need for mechanical ventilation, vasopressors, or renal-replacement therapy) were similar between the groups (P > .17 for all). Significantly smaller proportions of patients with ALF after immunosuppression than control subjects survived for 21 days (42.9% vs 62.5% of control subjects; . P = .0096). Factors associated with 21-day transplant-free survival (C statistic = 0.866) were increased Model for End-Stage Liver Disease score (odds ratio, 0.894 per increment), requirement for mechanical ventilation (odds ratio, 0.111), and immunosuppressive therapy (odds ratio, 0.274). Conclusions: Within a cohort study of patients with HBV-associated ALF, 18% had received immunosuppressive therapy. Significantly smaller proportions of patients with HBV-associated ALF after immunosuppression survive beyond 21 days than patients with HBV-associated ALF who did not receive immunosuppression. Patients undergoing chemotherapy should be screened for HBV infection and given appropriate antiviral therapies to reduce preventable mortality.

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KW - Acute Liver Failure

KW - Chemotherapy

KW - Hepatitis B

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