Tri-typing of hepatitis B-related acute-on-chronic liver failure defined by the World Gastroenterology Organization

J Gastroenterol Hepatol. 2021 Jan;36(1):208-216. doi: 10.1111/jgh.15113. Epub 2020 Jul 1.


Background and aim: Tri-typing of acute-on-chronic liver failure (ACLF), as proposed by the World Gastroenterology Organization (WGO), has not been validated in patients infected with hepatitis B virus (HBV). We aim to compare the three types of ACLF patients in clinic characteristics.

Methods: Hospitalized ACLF patients with chronic hepatitis B from five hepatology centers were retrospectively selected and grouped according to the WGO classification. For each group, we investigated laboratory tests, precipitating events, organ failure, and clinical outcome.

Results: Compared with type-B (n = 262, compensated cirrhosis) and type-C (n = 129, decompensated cirrhosis) ACLF, type-A patients (n = 195, non-cirrhosis) were associated with a younger age, the highest platelet counts, the highest aminotransferase levels, and the most active HBV replications. HBV reactivation were more predominant in type-A, while bacterial infections in type-B and type-C ACLF cases. Liver failure (97.4%) and coagulation failure (86.7%) were most common in type-A compared with type-B or type-C ACLF patients. Kidney failure was predominantly identified in type-C subjects (41.9%) and was highest (23/38, 60.5%) in grade 1 ACLF patients. Furthermore, type-C ACLF showed the highest 28-day (65.2%) and 90-day (75.3%) mortalities, compared with type-A (48.7% and 54.4%, respectively) and type-B (48.4% and 62.8%, respectively) ACLF cases. Compared with type-A (11.7%) ACLF patients, the increased mortality from 28 to 90 days was higher in type-B (31.6%) and type-C (37.5%).

Conclusion: Tri-typing of HBV-related ACLF in accordance with the WGO definition was able to distinguish clinical characteristics, including precipitating events, organ failure, and short-term prognosis in ACLF patients.

Keywords: Acute-on-chronic liver failure; Chronic hepatitis B virus infection; Liver cirrhosis; Prognosis.

MeSH terms

  • Acute-On-Chronic Liver Failure / classification*
  • Acute-On-Chronic Liver Failure / diagnosis
  • Acute-On-Chronic Liver Failure / etiology*
  • Acute-On-Chronic Liver Failure / mortality
  • Adult
  • Age Factors
  • China
  • Female
  • Gastroenterology / organization & administration*
  • Hepatitis B virus / physiology
  • Hepatitis B, Chronic / complications*
  • Hepatitis B, Chronic / virology
  • Humans
  • Male
  • Middle Aged
  • Platelet Count
  • Prognosis
  • Retrospective Studies
  • Tertiary Care Centers
  • Transaminases / blood
  • Virus Replication


  • Transaminases