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.
Hospitalized ACLF patients with chronic hepatitis B from 5 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.
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. Hepatitis B virus 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-day to 90-day was higher in type-B (31.6%) and type-C (37.5%).
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.

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