Objective

2

We aimed to explore the discrepancies in clinical features and outcomes between damp-heat stasis jaundice syndrome and qi-deficiency stasis jaundice syndrome in patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF).

Methods

2

We performed an analysis including 111 HBV-ACLF patients recruited from December 2017 to December 2021 in the Fifth Medical Center of Chinese PLA General Hospital. According to traditional Chinese medicine syndromes

these patients were divided into the dampness-heat stasis jaundice syndrome group(

n

=90) and the qi-deficiency stasis jaundice syndrome group(

n

=21). All patients adopt the standard internal medicine treatment plan. Baseline data

laboratory indicators

complications

and disease scores

including the model for end-stage liver disease (MELD)

MELD-Na

and Acute-on-Chronic Liver Failure(ACLF)Research Consortium (AARC) scores

were recorded. All patients were followed up to 90 days after enrollment. We compared the baseline demographic characteristics

90 d mortality

and complications of HBV-ACLF patients with different syndromes. The confounding factors were adjusted through Cox analysis to evaluate the impact of dampness-heat stasis jaundice syndrome and qi-deficiency stasis jaundice syndrome on the prognosis and the development of complications.

Results

2

There were differences in age

clinical indicators

and outcomes between HBV-ACLF patients with dampness-heat stasis jaundice syndrome group and the qi-deficiency stasis jaundice syndrome group. The patients with qi-deficiency stasis jaundice syndrome group had higher MELD scores

MELD-Na scores

and AARC scores. Compared to patients with dampness-heat stasis jaundice syndrome group

patients with qi-deficiency stasis jaundice syndrome group were older

had worse liver synthesis and reserve function of the liver

and had a milder inflammatory response

and the proportion of patients with cirrhosis was higher (

P

<

0.05). Patients with qi-deficiency stasis jaundice syndrome group had a higher cumulative mortality rate within 90 days than patients with dampness-heat stasis jaundice syndrome group(

P

=0.013). Qi-deficiency stasis jaundice syndrome was dependently associated with a higher mortality risk than dampness-heat stasis jaundice syndrome (

HR

=1.57

P

=0.014). Multivariate analysis showed that older age (

HR

=1.06

P

=0.006)

elevated total bilirubin levels (

HR

=1.11

P

=0.003)

hyponatremia (

HR

=1.86

P

=0.004)

renal dysfunction (

HR

=3.27

P

=0.027)

and a basis of cirrhosis (

HR

=2.12

P

=0.024) were risk factors for 90-day mortality

and elevated prothrombin activity (

HR

=0.94

P

=0.007) was a protective factor for 90-day mortality in HBV-ACLF patients. Additionally

patients with qi-deficiency stasis jaundice syndrome group had higher rates of new-onset spontaneous bacterial peritonitis

hepatic encephalopathy

and renal insufficiency than those with dampness-heat stasis jaundice syndrome group within 90 days(

P

<

0.05).

Conclusion

2

Our study suggested that qi-deficiency stasis jaundice syndrome is more serious than damp-heat stasis jaundice syndrome. Our multivariate analysis indicated that patients with qi-deficiency stasis jaundice syndrome had higher rates of mortality

new-onset spontaneous bacterial peritonitis

hepatic encephalopathy

and kidney dysfunction than patients with damp-heat stasis jaundice syndrome. This study preliminarily demonstrated that dampness-heat stasis jaundice syndrome and qi-deficiency stasis jaundice syndrome may hold significant value for disease conditions and prognosis prediction for HBV-ACLF patients.