Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2015 Sep 15;6(27):23261-71.
doi: 10.18632/oncotarget.4666.

Conditional survival estimate of acute-on-chronic hepatitis B liver failure: a dynamic prediction based on a multicenter cohort

Ming-Hua Zheng  1   2 , Sheng-Jie Wu  3 , Ke-Qing Shi  1   2 , Hua-Dong Yan  4 , Hai Li  5 , Gui-Qi Zhu  1   6 , Yao-Yao Xie  7 , Fa-Ling Wu  1   2 , Yong-Ping Chen  1   2
Affiliations
Multicenter Study

Conditional survival estimate of acute-on-chronic hepatitis B liver failure: a dynamic prediction based on a multicenter cohort

Ming-Hua Zheng et al. Oncotarget. .

Abstract

Objectives: Counseling patients with acute-on-chronic hepatitis B liver failure (ACHBLF) on their individual risk of short-term mortality is challenging. This study aimed to develop a conditional survival estimate (CSE) for predicting individualized mortality risk in ACHBLF patients.

Methods: We performed a large prospective cohort study of 278 ACHBLF patients from December 2010 to December 2013 at three participating medical centers. The Kaplan-Meier method was used to calculate the cumulative overall survival (OS). Cox proportional hazard regression models were used to analyze the risk factors associated with OS. 4-week CSE at "X" week after diagnostic established were calculated as CS4 = OS(X+4)/OS(X).

Results: The actual OS at 2, 4, 6, 8, 12 weeks were 80.5%, 71.8%, 69.3%, 66.0% and 63.7%, respectively. Using CSE, the probability of surviving an additional 4 weeks, given that the patient had survived for 1, 3, 5, 7, 9 weeks was 74%, 86%, 92%, 93%, 97%, respectively. Patients with worse prognostic feathers, including MELD > 25, Child grade C, age > 45, HE, INR > 2.5, demonstrated the greatest increase in CSE over time, when compared with the "favorable" one (Δ36% vs. Δ10%; Δ28% vs. Δ16%; Δ29% vs. Δ15%; Δ60% vs. Δ12%; Δ33% vs. Δ12%; all P < 0.001; respectively).

Conclusions: This easy-to-use CSE can accurately predict the changing probability of survival over time. It may facilitate risk communication between patients and physicians.

Keywords: Pathology Section; acute-on-chronic hepatitis B liver failure; conditional survival; prognosis; relative survival; risk factor.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST

The authors report no declarations of interest.

Figures

Figure 1
Figure 1. A. Hazard estimate of death in this large multicenter cohort and B. 4-week conditional survival estimate relative to actual survival
Figure 2
Figure 2. Overall survival stratified by
A. MELD score (log-rank P < 0.001), C. Child score (log-rank P < 0.001) and conditional survival estimates stratified by B. MELD score and D. Child score.
Figure 3
Figure 3. Overall survival stratified by
A. age (log-rank P < 0.001), C. hepatic encephalopathy (log-rank P < 0.001), E. international normalized ratio (log-rank P < 0.001) and conditional survival estimates stratified by B. age, D. hepatic encephalopathy and F. international normalized ratio.
Figure 4
Figure 4. Overall survival stratified by
A. total bilirubin (log-rank P = 0.003), C. creatinine (log-rank P < 0.001), E. alkaline phosphatase (log-rank P < 0.004) and conditional survival estimates stratified by B. total bilirubin, D. creatinine and F. alkaline p hosphatase.
See this image and copyright information in PMC

References

    1. Moreau R, Arroyo V. Acute on Chronic Liver Failure: A New Clinical Entity. Clin Gastroenterol Hepatol. 2015;13:836–841. - PubMed
    1. Sarin SK, Kumar A, Almeida JA, Chawla YK, Fan ST, Garg H, de Silva HJ, Hamid SS, Jalan R, Komolmit P, Lau GK, Liu Q, Madan K, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL) Hepatol Int. 2009;3:269–282. - PMC - PubMed
    1. Liu J, Fan D. Hepatitis B in China. Lancet. 2007;369:1582–1583. - PubMed
    1. Wu FL, Shi KQ, Chen YP, Braddock M, Zou H, Zheng MH. Scoring systems predict the prognosis of acute-on-chronic hepatitis B liver failure: an evidence-based review. Expert Rev Gastroenterol Hepatol. 2014;8:623–632. - PubMed
    1. Seto WK, Lai CL, Yuen MF. Acute-on-chronic liver failure in chronic hepatitis B. J Gastroenterol Hepatol. 2012;27:662–669. - PubMed

Publication types

LinkOut - more resources