Journal of hepatology | 2021
Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure.
Abstract
BACKGROUND & AIMS\nThe early prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is important to decrease its high mortality. This study aims to develop a new simplified prognostic score to accurately predict the outcome of these patients.\n\n\nMETHODS\nThe prospective clinical data of 2409 hospitalized patients with acute deterioration of HBV-related chronic liver disease were used to develop a new prognostic score that was validated by an external group.\n\n\nRESULTS\nA 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 the 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 four other scores (COSSH-ACLFs, 0.793/0.784; CLIF-C ACLFs, 0.792/0.770; MELDs, 0.731/0.727; MELD-Nas, 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 COSSH-ACLFs (15.9%), CLIF-C ACLFs (16.3%), MELDs (35.3%) and MELD-Nas (35.6%). The probability density function evaluation and risk stratification of the new score also showed the highest predictive values for mortality. The external group further validated these results.\n\n\nCONCLUSION\nThe new prognostic score based on six predictors without an assessment of organ failure can accurately predict and easily stratify the short-term mortality of patients with HBV-ACLF and might be used for early prognosis to decrease the high mortality.\n\n\nLAY SUMMARY\nHepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a complex syndrome with a high short-term mortality rate. We developed a simplified prognostic score for these patients based on a prospective multicentre cohort that showed the best predictive performance compared with four other generic prognostic scores (COSSH-ACLFs, CLIF-C ACLFs, MELDs and MELD-Nas).