Acute kidney injury in acute-on-chronic liver failure is different from in decompensated cirrhosis

AIM To evaluate the differences in acute kidney injury(AKI) between acute-on-chronic liver failure(ACLF) and decompensated cirrhosis(DC) patients. METHODS During the period from December 2015 to July 2017, 280 patients with hepatitis B virus(HBV)-related ACLF(HBV-ACLF) and 132 patients with HBV-related DC(HBV-DC) who were admitted to our center were recruited consecutively into an observational study. Urine specimens were collected from all subjects and the levels of five urinary tubular injury biomarkers were detected,including neutrophil gelatinase-associated lipocalin(NGAL), interleukin-18(IL-18), liver-type fatty acid binding protein(L-FABP), cystatin C(CysC), and kidney injury molecule-1(KIM-1). Simultaneously, the patient demographics, occurrence and progression of AKI, and response to terlipressin therapy were recorded. All patients were followed up for 3 mo or until death after enrollment. RESULTS AKI occurred in 71 and 28 of HBV-ACLF and HBV-DC patients, respectively(25.4% vs 21.2%, P = 0.358). Among all patients, the levels of four urinary biomarkers(NGAL, CysC, L-FABP, IL-18) were significantly elevated in patients with HBV-ACLF and AKI(ACLF-AKI), compared with that in patients with HBV-DC and AKI(DC-AKI) or those without AKI. There was a higher proportion of patients with AKI progression in ACLF-AKI patients than in DC-AKI patients(49.3% vs 17.9%, P = 0.013). Fortythree patients with ACLF-AKI and 19 patients with DC-AKI were treated with terlipressin. The response rate of ACLFAKI patients was significantly lower than that of patients with DC-AKI(32.6% vs 57.9%, P = 0.018). Furthermore, patients with ACLF-AKI had the lowest 90 d survival rates among all groups(P < 0.001).CONCLUSION AKI in ACLF patients is more likely associated with structural kidney injury, and is more progressive, with a poorer response to terlipressin treatment and a worse prognosis than that in DC patients.

Superinfective Hepatitis E Virus Infection Aggravates Hepatocytes Injury in Chronic Hepatitis B

Hepatitis E virus(HEV)infection is a major cause of morbidity in endemic areas.Its consequences among chronic hepatitis B(CHB)patients have been under-reported.The aim of this study was to assess the impact of superinfective HEV infection(acute and past)on virological and clinical features of patients with CHB infection.Clinical,biochemical,virological and immunological data of 153 CHB patients including 98 with hepatitis B virus(HBV)monoinfection and 55 with HBV-HEV superinfection with both HEV and HBV infection was retrospectively investigated and analyzed in this study conducted in Wuhan,China.An overall anti-HEV IgG seroprevalence was found to be 35.9% in CHB patients.HBV-HEV superinfection patients showed significantly higher rate of complications(ascites,hepato-renal syndrome&encephalopathy)(all with P=0.04),cirrhosis(P<0.001)and acute-on-chronic liver failure(P<0.001)than HBV monoinfection patients.They also displayed elevated ALTs(P<0.001)and total serum bilirubin(P<0.001)with diminished albumin(P<0.001)and HBV viral load(P<0.001).Cytokines assay revealed increased expression of IL-6(P=0.02),IL-10(P=0.009)and TNF-α(P=0.003)in HBVHEV superinfection patients compared to HBV monoinfection patients.Our study demonstrated that HEV superinfection in CHB patients was associated with progressive clinical manifestation,which is likely due to the enhanced expression of cytokines related with hepatocytes necrosis.HEV was also associated with repressed HBV replication,but the underlying mechanism requires further investigation.