A Study of AARC Standards on Diagnosis and Treatment of Patients With HBV-ACLF in China (AARC China Study)
A Study of AARC Standards on Diagnosis and Treatment of Patients With HBV-ACLF in China (AARC China Study)
The AARC China Study is to establish a widely recognized and harmonized standard of patients
 with HBV-ACLF in the Asia Pacific region.
Acute on chronic liver failure (ACLF) is a clinically critical illness and has been
 extensively researched around the world. However, there is a potential "communication
 barrier" in the ACLF study; that is, different countries and regions, or different research
 collaboration groups, follow different ACLF definitions and related standards, making
 researchers in this field confuse in understanding the research value of relevant research
 and interpreting the research results. Important differences exist in the Asia-Pacific region
 and North America and Europe, such as the etiology, the clinical characteristics of the
 patient group, the requirements for cirrhosis, and the predisposing factors of the disease,
 making it necessary for China or the Asia-Pacific region to develop appropriate ACLF
 diagnosis standards and prognosis. In recent years, Chinese experts have also focused on the
 research progress of APASL ACLF Research Consortium (AARC) in the Asia-Pacific region. It is
 found that the AARC standards are more suitable for the diagnosis and treatment of patients
 with ACLF in China than the Western standards. The ACLF prediction model (TPPM model)
 established by Professor Qin.N's team predicts that the prognostic efficacy of patients with
 HBV-ACLF is significantly better than that of Western prognosis. The AARC China Study is to
 establish a widely recognized and harmonized standard of patients with HBV-ACLF in the Asia
 Pacific region.
Inclusion Criteria:

 -  Chronic liver disease: Chronic hepatitis B

 -  Acute deterioration of liver function: more than one of the below criteria

 1. development of new ascites within 4 weeks or re-emergence of ascites who have
 previous well controlled ascites (greater than or equal to grade 2 or 3;
 International ascites club criteria)

 2. development of hepatic encephalopathy

 3. development of gastrointestinal hemorrhage

 4. development of jaundice (serum bilirubin greater than or equal to 3mg/dl)

 5. development of bacterial infection

 -  spontaneous bacteremia: positive blood cultures without a source of infection

 -  spontaneous bacterial peritonitis: ascitic fluid polymorphonuclear cells >250/µL

 -  lower respiratory tract infections: new pulmonary infiltrate in the presence of: i) at
 least one respiratory symptom (cough, sputum production, dyspnea, pleuritic pain) with
 ii) at least one finding on auscultation (rales or crepitation) or one sign of
 infection (core body temperature >38_C or less than 36_C, shivering, or leukocyte
 count >10,000/mm3 or <4,000/mm3) in the absence of antibiotics

 -  Clostridium difficile Infection: diarrhea with a positive C. difficile assay

 -  bacterial entero-colitis: diarrhea or dysentery with a positive stool culture for
 Salmonella, Shigella, Yersinia, Campylobacter, or pathogenic E. coli;

 -  soft-tissue/skin Infection: fever with cellulitis

 -  urinary tract infection (UTI): urine white blood cell >15/high-power field with either
 positive urine gram stain or culture;

 -  intra-abdominal infections: diverticulitis, appendicitis, cholangitis, etc.

 -  other infections not covered above;

 -  fungal infections as a separate category.

 Exclusion Criteria:

 -  Patients who do not have chronic liver disease

 -  Patients who have hepatocellular carcinoma

 -  Patients who admitted for extrahepatic manifestations

 -  Patients who have HIV infection

 -  Patients who admitted for symptomatic control of chronic liver disease, other than
 acute deterioration of liver function