Abstract
Aims and objectivesAcute-on-chronic hepatitis B liver failure (ACHBLF) is a critical clinical syndrome with a high short-term mortality evolved from chronic hepatitis B (CHB)-related liver disease. Prediction of mortality risk and early intervention can improve the prognosis of patients. This study aimed to develop and validate the nomogram for short-time mortality estimation in ACHBLF patients defined according to Asian Pacific Association for the Study of the Liver (APASL).MethodsA study of 105 ACHBLF patients with 90-day follow up was performed to develop the nomogram. Patients were randomly assigned to derivation cohort (n = 75) and validation cohort (n = 35) according to 7:3. Concordance index (C-index), calibration curve and decision curve analysis (DCA) were used to evaluate the nomogram. We also compared the nomogram with APASL ACLF research consortium (AARC) score, model for end-stage liver disease (MELD) score, MELD with serum sodium (MELD-Na) score and albumin-bilirubin (ALBI) score. The nomogram was validated using an external cohort including 40 patients.ResultsThe 28-day and 90-day mortality of 105 patients were respectively 49.52% and 55.24%. Albumin (ALB), international normalized ratio (INR) and estimated glomerular filtration rate (eGFR) were independent predictors for 28-day mortality; INR and eGFR were independent predictors for 90-day mortality. C-index of Nomogram-1 for 28-day mortality and Nomogram-2 for 90-day mortality were respectively 0.82 and 0.81. Calibration curve and Hosmer–Lemeshow test (Nomogram-1, 0.323; Nomogram-2, 0.231) showed optimal agreement between observed and predicted death. Areas under receiver operator characteristic curve(AUROC) of Nomogram-1(0.772) and Nomogram-2(0.771) were larger compared with AARC, MELD, MELD-Na and ALBI score. The results were well estimated in the external validation cohort.ConclusionsThis study highlighted the predictive value of eGFR, and the nomogram based on INR and eGFR could effectively estimate individualized risk for short-term mortality of ACHBLF patients defined according to APASL.
Highlights
Acute-on-chronic liver failure (ACLF) is a critical clinical syndrome with acute decompensation of liver function based on chronic liver disease, characterized by systemic inflammation and high short-term mortality [1,2,3]
We aimed to develop and validate a nomogram to predict 28-day and 90-day mortality of acute-onchronic hepatitis B liver failure (ACHBLF) patients defined according to Asian Pacific Association for the Study of the Liver (APASL)
Patient characteristics We collected clinical data of 168 ACLF patients, and 105 patients were enrolled in accordance with the criteria (Fig. 1)
Summary
Acute-on-chronic liver failure (ACLF) is a critical clinical syndrome with acute decompensation of liver function based on chronic liver disease, characterized by systemic inflammation and high short-term mortality [1,2,3]. It can be accompanied by multi-organ dysfunction and progressed very rapidly. AARC score is more complex and enrolls subjective factors, such as HE grades, which brings inconvenience to the wide promotion of clinical practice Both AARC score and MELD score took into consideration extrahepatic organ failure, such as acute renal injury(AKI), and enrolled Cr as an evaluation index. Cr was affected by external factors and couldn’t accurately represent AKI, so we aimed to enroll eGFR as a predictor, which could evaluate AKI more accurately
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