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Liver FailureNCT03992898

Nomogram Analysis for HBV Related Acute-on-chronic Liver Failure

An observational study of Liver Failure, run by Sun Yat-sen University at 1 site in China.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Acute-on-chronic liver failure (ACLF) is an acute deterioration of chronic liver diseases, which progresses rapidly, with a mortality rate of more than 50%.MELD score is used to evaluate the patients' condition. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Liver Failure
What is being tested?
No special intervention was suitable for this observational study
How many people
2,739 participants
Where
1 siteChina
Study dates
1 Jan 2019to 1 Nov 2019
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Study population: The investigators will enroll a retrospective cohort of HBV related acute-on-chronic liver failure patients who were admitted to The Third affiliated Hospital of Sun Yat-sen University from January 2010 to March 2018.

Who may be able to join

  • Age ≥ 18 years; Serum total bilirubin ≥ 10 mg/dl; International normalized ratio≥1.5 or prothrombin activity <40%; Complicated within 4 weeks by ascites and/or encephalopathy; Positive serum hepatitis B surface antigen for more than 6 months.

Who cannot join

  • Drug induce liver diseases; Autoimmune liver diseases; Alcohol or drug abusers (average alcohol consumption >40g/d for men, >20g/d for women); Liver diseases caused by metabolic factors; Superinfection with hepatitis A, C, D, E viruses; Infected by HIV virus; Pregnancy or lactation; Liver failure caused by recurrence of hepatitis b after transplantation.

Trial locations and contacts

1 site in 1 country.

China1 site
  • The Third Affiliated Hospital of Sun Yat-sen University

    Guangzhou, Guangdong, 510630

Other trials in China

About this study

Official title: Establishment and Validation of Prognostic Nomograms for HBV-related Acute-on-Chronic Liver Failure in South of China

Acute-on-chronic liver failure (ACLF) is an acute deterioration of chronic liver diseases, which progresses rapidly, with a mortality rate of more than 50%.MELD score is used to evaluate the patients' condition. However, MELD score only concerned about the variables of total bilirubin, international normalize ratio (INR) and creatinine which is not enough to access ACLF patients' condition accurately.

Scholars of US and China suggested to divided ACLF patients into 3 subgroups base on the different "chronic liver disease" . Type A ACLF patients have chronic liver disease without cirrhosis. Type B ACLF patients with compensated cirrhosis, while type C ACLF patients with decompensated cirrhosis. Currently, no studies have assessed the prognosis of different types of ACLF patients, especially for HBV-related ACLF patients.

Investigators conducted a retrospective study which enrolls HBV-related ACLF patients between January 2010 and March 2018 in the Third Affiliated Hospital of Sun Yat-sen University. Clinical data, survival time and information regarding liver transplantation after enrolment were collected. A nomogram was formulated based on the results of multivariable Cox regression analysis. The performance of the nomogram was evaluated by the concordance index (C-index) and assessed by comparing nomogram-predicted vs observed Kaplan-Meier estimates of survival probability, and bootstraps with 1000 resamples were applied to these activities. Comparisons between the nomogram, MELD Score,MELD-Na Score and CTP Score in the entire population were performed and were tested by the C-index. A larger C-index indicated more accurate prognostic stratification.

Read the detailed description

Acute-on-chronic liver failure (ACLF) is an acute deterioration of chronic liver diseases, which progresses rapidly, with a mortality rate of more than 50%. Liver transplantation is the only therapy that has been proven beneficial, but the number of liver donor is limited. MELD score is used to evaluate the patients' condition before transplantation to decide who is in greatest need. However, MELD score only concerned about the variables of total bilirubin, international normalize ratio (INR) and creatinine. Other important valuables such as age, hepatic encephalopathy, and indexes of infection (e.g. white blood cell counts) were excluded. Many studies showed that application of MELD score only is not enough to access the liver failure patients' condition accurately.

Both APASL and Chinese Society of Infectious Disease considered the "chronic liver disease" included chronic liver disease with/without cirrhosis. Scholars of US and China suggested to divided ACLF patients into 3 subgroups base on the different "chronic liver disease" . Type A ACLF patients have chronic liver disease without cirrhosis. Type B ACLF patients with compensated cirrhosis, while type C ACLF patients with decompensated cirrhosis. Currently, no studies have assessed the prognosis of different types of ACLF patients, especially for HBV-related ACLF patients.

Investigators conducted a retrospective study which enrolls HBV-related ACLF patients between January 2010 and March 2018 in the Third Affiliated Hospital of Sun Yat-sen University. Clinical data of demographic data, admission causes, cirrhosis complications, and precipitating events associated with acute decompensation or severe liver injury, laboratory measurements (e.g., serum albumin, sodium, alanine aminotransferase, aspartate aminotransferase, total bilirubin, INR and creatinine levels), mean arterial pressure, HBV infection biomarkers, HBV-DNA levels, antiviral treatment for HBV (nucleoside analogues, including lamivudine, adefovir, entecavir, telbivudine and tenofovir, within 6 months prior to and during hospitalisation), and prognosis would be collected. Survival time and information regarding liver transplantation after enrolment were also collected. A nomogram was formulated based on the results of multivariable Cox regression analysis. The performance of the nomogram was evaluated by the concordance index (C-index) and assessed by comparing nomogram-predicted vs observed Kaplan-Meier estimates of survival probability, and bootstraps with 1000 resamples were applied to these activities. Comparisons between the nomogram, MELD Score, MELD-Na Score and CTP Score in the entire population were performed and were tested by the C-index. A larger C-index indicated more accurate prognostic stratification.

Conditions
Liver Failure
Being tested
No special intervention was suitable for this observational study
Medical subject headings
Liver Failure

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • No special intervention was suitable for this observational studyOther

    Investegators divided patients into 3 corhort according to the liver condition at enrollment (i.e. chronic liver disease, compemsated cirrhosis, decompensated cirrhosis). All patients received standard medical treatment, including nutritional supplementation; administration of human serum albumin, fresh frozen plasma, antivirus treatment and appropriate treatment for complications. No special intervention was suitable for this observational study.

Study groups in NCT03992898
Study groupRoleWhat they receive
Chronic hepatitis cohortIn this cohort, patients were defined as type A acute-on-chronic liver failure (ACLF) patients who have chronic liver disease but without cirrhosis.
Receives: Other: No special intervention was suitable for this observational study
Cirrhosis cohortIn this cohort, patients were defined as type B and type C ACLF patients with cirrhosis.
Receives: Other: No special intervention was suitable for this observational study

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. survival status

    Patients will be follow-up for 90 days until death or received liver transplantation. And survival days of each patients will be recorded.

    Measured: 90 days

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Jun 2019
  2. Study start1 Jan 2019
  3. Primary completion1 Oct 2019
  4. Study completion1 Nov 2019

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Retrospective
Enrolment
2,739 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03992898
Sponsor's protocol ID
Survival Study Cohort(SSC001)
Status last verified
Jan 2020
First submitted
19 Jun 2019
Last updated
6 Jan 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Lin B, Pan CQ, Xie D, Xie J, Xie S, Zhang X, Wu B, Lin C, Gao Z. Entecavir improves the outcome of acute-on-chronic liver failure due to the acute exacerbation of chronic hepatitis B. Hepatol Int. 2013 Jun;7(2):460-7. doi: 10.1007/s12072-012-9415-y. Epub 2013 Feb 11.

    PubMed 26201778
  • Duseja A, Choudhary NS, Gupta S, Dhiman RK, Chawla Y. APACHE II score is superior to SOFA, CTP and MELD in predicting the short-term mortality in patients with acute-on-chronic liver failure (ACLF). J Dig Dis. 2013 Sep;14(9):484-90. doi: 10.1111/1751-2980.12074.

    PubMed 23692973
  • Peng Y, Qi X, Tang S, Deng H, Li J, Ning Z, Dai J, Hou F, Zhao J, Wang R, Guo X. Child-Pugh, MELD, and ALBI scores for predicting the in-hospital mortality in cirrhotic patients with acute-on-chronic liver failure. Expert Rev Gastroenterol Hepatol. 2016 Aug;10(8):971-80. doi: 10.1080/17474124.2016.1177788. Epub 2016 Apr 25.

    PubMed 27070325
  • Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, Durand F, Gustot T, Saliba F, Domenicali M, Gerbes A, Wendon J, Alessandria C, Laleman W, Zeuzem S, Trebicka J, Bernardi M, Arroyo V; CANONIC Study Investigators of the EASL-CLIF Consortium. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013 Jun;144(7):1426-37, 1437.e1-9. doi: 10.1053/j.gastro.2013.02.042. Epub 2013 Mar 6.

    PubMed 23474284
  • Jalan R, Pavesi M, Saliba F, Amoros A, Fernandez J, Holland-Fischer P, Sawhney R, Mookerjee R, Caraceni P, Moreau R, Gines P, Durand F, Angeli P, Alessandria C, Laleman W, Trebicka J, Samuel D, Zeuzem S, Gustot T, Gerbes AL, Wendon J, Bernardi M, Arroyo V; CANONIC Study Investigators; EASL-CLIF Consortium. The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure. J Hepatol. 2015 Apr;62(4):831-40. doi: 10.1016/j.jhep.2014.11.012. Epub 2014 Nov 22.

    PubMed 25463539
  • Silva PE, Fayad L, Lazzarotto C, Ronsoni MF, Bazzo ML, Colombo BS, Dantas-Correa EB, Narciso-Schiavon JL, Schiavon LL. Single-centre validation of the EASL-CLIF consortium definition of acute-on-chronic liver failure and CLIF-SOFA for prediction of mortality in cirrhosis. Liver Int. 2015 May;35(5):1516-23. doi: 10.1111/liv.12597. Epub 2014 Jun 6.

    PubMed 24840673
  • Jalan R, Yurdaydin C, Bajaj JS, Acharya SK, Arroyo V, Lin HC, Gines P, Kim WR, Kamath PS; World Gastroenterology Organization Working Party. Toward an improved definition of acute-on-chronic liver failure. Gastroenterology. 2014 Jul;147(1):4-10. doi: 10.1053/j.gastro.2014.05.005. Epub 2014 May 20. No abstract available.

    PubMed 24853409
  • Luo Y, Xu Y, Li M, Xie Y, Gong G. A new multiparameter integrated MELD model for prognosis of HBV-related acute-on-chronic liver failure. Medicine (Baltimore). 2016 Aug;95(34):e4696. doi: 10.1097/MD.0000000000004696.

    PubMed 27559979
  • Shi KQ, Cai YJ, Lin Z, Dong JZ, Wu JM, Wang XD, Song M, Wang YQ, Chen YP. Development and validation of a prognostic nomogram for acute-on-chronic hepatitis B liver failure. J Gastroenterol Hepatol. 2017 Feb;32(2):497-505. doi: 10.1111/jgh.13502.

    PubMed 27490495
  • Chen JF, Weng WZ, Huang M, Peng XH, Zhang J, Xiong J, He JR, Zhang SQ, Cao HJ, Gao B, Lin DN, Gao J, Gao ZL, Lin BL. The impact of serum thyroid-stimulation hormone levels on the outcome of hepatitis B virus related acute-on-chronic liver failure: an observational study. BMC Gastroenterol. 2022 Jul 7;22(1):330. doi: 10.1186/s12876-022-02406-7.

    PubMed 35799116
  • Weng WZ, Chen JF, Peng XH, Huang M, Zhang J, Xiong J, Cao HJ, Lin BL. Risk factors for underlying comorbidities and complications in patients with hepatitis B virus-related acute-on-chronic liver failure. Epidemiol Infect. 2022 Jul 5;150:e147. doi: 10.1017/S0950268822001169.

    PubMed 35788251
  • Chen JF, Weng WZ, Huang M, Peng XH, He JR, Zhang J, Xiong J, Zhang SQ, Cao HJ, Gao B, Lin DN, Gao J, Gao ZL, Lin BL. Derivation and Validation of a Nomogram for Predicting 90-Day Survival in Patients With HBV-Related Acute-on-Chronic Liver Failure. Front Med (Lausanne). 2021 Jun 16;8:692669. doi: 10.3389/fmed.2021.692669. eCollection 2021.

    PubMed 34222294

Questions about this trial

What is this clinical trial studying?

An observational study of Liver Failure, run by Sun Yat-sen University at 1 site in China.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 6 Jan 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in China. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

survival status (time frame: 90 days). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03992898, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Jan 2020.

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