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. 2021 Nov;75(5):1104-1115.
doi: 10.1016/j.jhep.2021.05.026. Epub 2021 Jun 4.

Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure

Jiaqi Li  1 , Xi Liang  2 , Shaoli You  3 , Tingting Feng  4 , Xin Zhou  5 , Bing Zhu  3 , Jinjin Luo  1 , Jiaojiao Xin  6 , Jing Jiang  6 , Dongyan Shi  6 , Yingyan Lu  7 , Keke Ren  1 , Tianzhou Wu  2 , Lingling Yang  8 , Jiang Li  9 , Tan Li  1 , Qun Cai  1 , Suwan Sun  1 , Beibei Guo  1 , Xingping Zhou  1 , Jiaxian Chen  1 , Lulu He  1 , Peng Li  1 , Hui Yang  1 , Wen Hu  1 , Zhanglu An  10 , Xiaojun Jin  10 , Jin Tian  5 , Baoju Wang  11 , Xin Chen  12 , Shaojie Xin  13 , Jun Li  14 ; Chinese Group on the Study of Severe Hepatitis B (COSSH)
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Free article

Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure

Jiaqi Li et al. J Hepatol. 2021 Nov.
Free article

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.

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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.

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