Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure
作者：Jiaqi Li, Xi Liang, Xi Liang, Shaoli You, Tingting Feng, Bing Zhu, Bing Zhu, Jinjin Luo, Jiaojiao Xin, Jing Jiang, Dongyan Shi, Yingyan Lu, Keke Ren, Tianzhou Wu, L T Yang, Tan Li, Jiang Li, Li T, Qun Cai, Suwan Sun, Bo Guo, Xingping Zhou, Jiaxian Chen, Lulu He, Peng Li, Zhanglu An, Wen Hu, Jin Tian, Xiaojun Jin, Jin Tian, Baoju Wang, Xin Chen, Shaojie Xin, Jun Li, Jun Li · 发表于：Journal of Hepatology · 年份：2021 · DOI：10.1016/j.jhep.2021.05.026 · 被引用次数：155 · 研究领域：Liver Disease and Transplantation、Hepatitis B Virus Studies、Hepatitis C virus research
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 ...