Academic Journal
Severe hepatitis B flare and liver failure: current assessment and management.
| Τίτλος: | Severe hepatitis B flare and liver failure: current assessment and management. |
|---|---|
| Συγγραφείς: | Lim SG; Division of Gastroenterology and Hepatology, Department of Medicine, National University Health System, Singapore. mdclimsg@nus.edu.sg.; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. mdclimsg@nus.edu.sg., Buti M; Liver Unit, Hospital General Universitari Valle Hebron, Barcelona, Spain., Feld JJ; Toronto Center for Liver Disease, Toronto General Hospital, University of Toronto, Toronto, ON, Canada., Fung J; Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR., Gehring AJ; Toronto Center for Liver Disease, Toronto General Hospital, University of Toronto, Toronto, ON, Canada., Reddy KR; Department of Medicine, University of Pennsylvania, Philadelphia (K.R.R.), PA, USA. |
| Πηγή: | Clinical and molecular hepatology [Clin Mol Hepatol] 2026 Jul; Vol. 32 (3), pp. 1117-1134. Date of Electronic Publication: 2026 Mar 18. |
| Τύπος έκδοσης: | Journal Article; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Korean Association for the Study of the Liver Country of Publication: Korea (South) NLM ID: 101586730 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2287-285X (Electronic) Linking ISSN: 22872728 NLM ISO Abbreviation: Clin Mol Hepatol Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Seoul, Korea : Korean Association for the Study of the Liver |
| Ιατρικοί όροι (MeSH): | Hepatitis B, Chronic*/complications , Hepatitis B, Chronic*/drug therapy , Hepatitis B, Chronic*/diagnosis , Liver Failure*/diagnosis, Antiviral Agents/therapeutic use ; Acute-On-Chronic Liver Failure/diagnosis ; Acute-On-Chronic Liver Failure/etiology ; Alanine Transaminase/blood ; Hepatitis B virus/genetics ; DNA, Viral/blood ; Humans ; Liver Transplantation ; Prognosis ; Viral Load |
| Περίληψη: | Hepatitis B flare is a common complication of chronic hepatitis B and is defined as an increase in HBV viral load associated with abnormal alanine aminotransferases (ALT), the consensus being an ALT level ≥5 times the upper limit of normal. The immunopathogenesis is related to induction of inflammatory cells and cytokines by the rise in HBV DNA. There are multiple causes of flares, and they carry the risk of progression to hepatic decompensation and acute-on-chronic liver failure (ACLF) with associated mortality, potentially requiring liver transplantation. Initial assessment should exclude other causes of liver dysfunction and determine severity and prognosis. General prognostic models of ACLF are useful but the COSSH-ACLF II score is specific to HBV. Early initiation of nucleos(t)ide analogues is crucial, even in severe HBV flares; it can reduce mortality by 73.6%. Once jaundice and coagulopathy occur, salvage by antivirals is challenging, and liver transplantation should be considered. However, many patients may not be suitable candidates for transplant or donor livers may not be available, as is common in Asia. Recently, there has been increasing evidence of the benefits of adjunctive therapies such as corticosteroids and plasma exchange, but there are associated risks and these approaches should be considered rescue therapies in severe HBV flares or ACLF. Liver transplant is the ultimate intervention when these other strategies fail. In summary, HBV flares are clinically serious events that can lead to hepatic decompensation, ACLF, and the need for a donor liver; however, strategies for rescue should be considered before liver transplantation. |
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| Grant Information: | NMRC/TCR/014-NUHS/2015 National Medical Research Council; NMRC/CIRG/1351/2013 National Medical Research Council; NMRC/CSASI/0016/2017 National Medical Research Council; NMRC/CIRG/1479/2017 National Medical Research Council; NMRC/OFLCG-19May-0038 National Medical Research Council |
| Contributed Indexing: | Keywords: Acute-on-chronic liver failure; Alanine transaminase; Hepatitis B, chronic; Hepatitis B, chronic/therapy; Plasma exchange |
| Substance Nomenclature: | 0 (Antiviral Agents) EC 2.6.1.2 (Alanine Transaminase) 0 (DNA, Viral) |
| Entry Date(s): | Date Created: 20260318 Date Completed: 20260731 Latest Revision: 20260813 |
| Update Code: | 20260813 |
| PubMed Central ID: | PMC13430368 |
| DOI: | 10.3350/cmh.2026.0177 |
| PMID: | 41846518 |
| Βάση Δεδομένων: | MEDLINE |
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