Abstract
Background & AimsTo establish an effective prognostic nomogram for acute-on-chronic hepatitis B liver failure (ACHBLF).Materials and MethodsThe nomogram was based on clinical data of 203 ACHBLF patients who admitted to the First Affiliated Hospital of Fujian Medical University from 2009 to 2014. The area under the receiver-operating characteristic curve (AUC) and calibration curve were carried out to verify the predictive accuracy ability of the nomogram. The result was validated in internal and external validation cohorts. Kaplan-Meier survival curve was used in survival analysis.ResultsWe developed a new prognostic nomogram to predict 3-month mortality based on risk factors selected by multivariate analysis. This nomogram consisted three independent factors: age, liver to abdominal area ratio (LAAR) and model for end-stage liver disease (MELD) score. The AUC of this nomogram for survival prediction was 0.877 (95% CI 0.831–0.923), which was higher than that of MELD score, MELD-Na and Child-Turcotte-Pugh (CTP). Good agreement of calibration plot for the probability of survival at 3-month was shown between the prediction by nomogram and actual observation. These results were supported by internal and external validation studies.ConclusionsThe ACHBLF nomogram could predict the short-term survival for ACHBLF patients.
Highlights
Acute-on-chronic liver failure (ACLF) is characterized by a precipitating event in patients with underlying chronic liver disease, leading to acute deterioration of liver function and often ending in multiorgan system failure [1]
We developed a new prognostic nomogram to predict 3-month mortality based on risk factors selected by multivariate analysis
The area under the receiver-operating characteristic curve (AUC) of this nomogram for survival prediction was 0.877, which was higher than that of model for end-stage liver disease (MELD) score, MELD-serum sodium (Na) and Child-Turcotte-Pugh (CTP)
Summary
Acute-on-chronic liver failure (ACLF) is characterized by a precipitating event in patients with underlying chronic liver disease, leading to acute deterioration of liver function and often ending in multiorgan system failure [1]. About 650,000 people worldwide die from liver failure, cirrhosis, and hepatocellular carcinoma, which are caused by hepatitis B virus (HBV) infection each year [2]. HBV has been the major cause of ACLF in the developing countries in Asia. Identification of patients with poor prognosis can reduce mortality of this disease [3]. A model that can predict short-term mortality in ACLF patients is necessary for clinicians. To establish an effective prognostic nomogram for acuteon-chronic hepatitis B liver failure (ACHBLF)
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