Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure
Jiaqi Li, Xi Liang, Shaoli You, Tingting Feng, Xin Zhou, Bing Zhu, Jinjin Luo, Jiaojiao Xin, Jing Jiang, Dongyan Shi, Yingyan Lu, Keke Ren, Tianzhou Wu, Lingling Yang, Jiang Li, Tan Li, Qun Cai, Suwan Sun, Beibei Guo, Xingping Zhou, Jiaxian Chen, Lulu He, Peng Li, Hui Yang, Wen Hu, Zhanglu An, Xiaojun Jin, Jin Tian, Baoju Wang, Xin Chen, Shaojie Xin, Jun Li, Chinese Group on the Study of Severe Hepatitis B (COSSH), Jiaqi Li, Xi Liang, Shaoli You, Tingting Feng, Xin Zhou, Bing Zhu, Jinjin Luo, Jiaojiao Xin, Jing Jiang, Dongyan Shi, Yingyan Lu, Keke Ren, Tianzhou Wu, Lingling Yang, Jiang Li, Tan Li, Qun Cai, Suwan Sun, Beibei Guo, Xingping Zhou, Jiaxian Chen, Lulu He, Peng Li, Hui Yang, Wen Hu, Zhanglu An, Xiaojun Jin, Jin Tian, Baoju Wang, Xin Chen, Shaojie Xin, Jun Li, Chinese Group on the Study of Severe Hepatitis B (COSSH)
Abstract
Background & aims: Early determination of the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is important to guide clinical management and decrease mortality. The aim of this study was to develop a new simplified prognostic score to accurately predict outcomes in patients with HBV-ACLF.
Methods: Prospective clinical data from 2,409 hospitalized patients with acute deterioration of HBV-related chronic liver disease were used to develop a new prognostic score that was validated in an external group.
Results: A total of 954 enrolled patients with HBV-ACLF were diagnosed based on the Chinese Group on the Study of Severe Hepatitis B-ACLF (COSSH-ACLF) criteria. Six predictive factors were significantly related to 28-day mortality and constituted a new prognostic score (=1.649×ln(international normalized ratio)+0.457×hepatic encephalopathy score+0.425×ln(neutrophil)+0.396×ln(total bilirubin)+0.576×ln(serum urea)+0.033×age). The C-indices of the new score for 28-/90-day mortality (0.826/0.809) were significantly higher than those of 4 other scores (COSSH-ACLF, 0.793/0.784; CLIF-C ACLF, 0.792/0.770; MELD, 0.731/0.727; MELD-Na, 0.730/0.726; all p <0.05). The prediction error rates of the new score for 28-day mortality were significantly lower than those of the 4 other scores: COSSH-ACLF (15.9%), CLIF-C ACLF (16.3%), MELD (35.3%) and MELD-Na (35.6%). The probability density function evaluation and risk stratification of the new score also showed the highest predictive values for mortality. These results were then validated in an external cohort.
Conclusion: A new prognostic score based on 6 predictors, without an assessment of organ failure, can accurately predict short-term mortality in patients with HBV-ACLF and might be used to guide clinical management.
Lay summary: Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a complex syndrome that is associated with a high short-term mortality rate. We developed a simplified prognostic score for patients suffering from this condition based on a prospective multicentre cohort. This new score had better predictive ability than 4 other commonly used scores.
Keywords: ACLF; HBV; probability density function; prognostic score; risk stratification.
Conflict of interest statement
Conflict of interest The authors declare no conflicts of interest that pertain to this work. Please refer to the accompanying ICMJE disclosure forms for further details.
Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.
Source: PubMed