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. 2016 Jun 4:16:59.
doi: 10.1186/s12911-016-0302-7.

Logistic regression model can reduce unnecessary artificial liver support in hepatitis B virus-associated acute-on-chronic liver failure: decision curve analysis

Gang Qin  1   2 , Zhao-Lian Bian  3 , Yi Shen  4 , Lei Zhang  5 , Xiao-Hong Zhu  3 , Yan-Mei Liu  4 , Jian-Guo Shao  6
Affiliations

Logistic regression model can reduce unnecessary artificial liver support in hepatitis B virus-associated acute-on-chronic liver failure: decision curve analysis

Gang Qin et al. BMC Med Inform Decis Mak. .

Abstract

Background: Several models have been proposed to predict the short-term outcome of acute-on-chronic liver failure (ACLF) after treatment. We aimed to determine whether better decisions for artificial liver support system (ALSS) treatment could be made with a model than without, through decision curve analysis (DCA).

Methods: The medical profiles of a cohort of 232 patients with hepatitis B virus (HBV)-associated ACLF were retrospectively analyzed to explore the role of plasma prothrombin activity (PTA), model for end-stage liver disease (MELD) and logistic regression model (LRM) in identifying patients who could benefit from ALSS. The accuracy and reliability of PTA, MELD and LRM were evaluated with previously reported cutoffs. DCA was performed to evaluate the clinical role of these models in predicting the treatment outcome.

Results: With the cut-off value of 0.2, LRM had sensitivity of 92.6 %, specificity of 42.3 % and an area under the receiving operating characteristic curve (AUC) of 0.68, which showed superior discrimination over PTA and MELD. DCA revealed that the LRM-guided ALSS treatment was superior over other strategies including "treating all" and MELD-guided therapy, for the midrange threshold probabilities of 16 to 64 %.

Conclusions: The use of LRM-guided ALSS treatment could increase both the accuracy and efficiency of this procedure, allowing the avoidance of unnecessary ALSS.

Keywords: Acute-on-chronic liver failure; Decision curve analysis; Hepatitis B virus; Logistic regression model; Model for end-stage liver disease.

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Figures

Fig. 1
Fig. 1
A decision tree of ALSS treatment for HBV-ACLF patients. The a, b, c, and d give, respectively, the value of true positive, false positive, false negative, and true negative
Fig. 2
Fig. 2
Cumulative survival in HBV-ACLF patients over follow-up of 90 days
Fig. 3
Fig. 3
Decision curve for prediction of net benefit in ALSS treatment for HBV-ACLF patients. Red line: assume no patient was treated with ALSS (“treat none”). Green dash line: assume all patients were treated with ALSS (“treat all). Pink line: assume only patients with higher PTA (>30 %) were treated with ALSS. Yellow line: patients were treated with random ALSS assignment. Purple line: assume only patients with low MELD scores (<30) were treated with ALSS. Blue line: assume only patients with low LRM scores (<0.2) were treated with ALSS
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