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

被引：136

作者：

Li, Jiaqi ^{[1
]}

Liang, Xi ^{[2
]}

You, Shaoli ^{[3
]}

Feng, Tingting ^{[4
]}

Zhou, Xin ^{[5
]}

Zhu, Bing ^{[3
]}

Luo, Jinjin ^{[1
]}

Xin, Jiaojiao ^{[1
,2
]}

Jiang, Jing ^{[1
,2
]}

Shi, Dongyan ^{[1
,2
]}

Lu, Yingyan ^{[6
]}

Ren, Keke ^{[1
]}

Wu, Tianzhou ^{[2
]}

Yang, Lingling ^{[7
]}

Li, Jiang ^{[8
]}

Li, Tan ^{[1
]}

Cai, Qun ^{[1
]}

Sun, Suwan ^{[1
]}

Guo, Beibei ^{[1
]}

Zhou, Xingping ^{[1
]}

Chen, Jiaxian ^{[1
]}

He, Lulu ^{[1
]}

Li, Peng ^{[1
]}

Yang, Hui ^{[1
]}

Hu, Wen ^{[1
]}

An, Zhanglu ^{[9
]}

Jin, Xiaojun ^{[9
]}

Tian, Jin ^{[5
]}

Wang, Baoju ^{[5
]}

Chen, Xin ^{[10
,11
,12
,13
]}

Xin, Shaojie ^{[3
]}

Li, Jun ^{[1
,2
]}

机构：

[1] Zhejiang Univ, Sch Med,State Key Lab Diag & Treatment Infect Dis, Affiliated Hosp 1,Natl Clin Res Ctr Infect Dis, Collaborat Innovat Ctr Diag & Treatment Infect Di, 79 Qingchun Rd, Hangzhou 310003, Peoples R China

[2] Taizhou Univ Hosp, Taizhou Cent Hosp, Precis Med Ctr, Taizhou, Peoples R China

[3] Chinese Peoples Liberat Army Gen Hosp, Med Ctr 5, Dept Liver Dis, Beijing, Peoples R China

[4] Suzhou Univ, Affiliated Hosp 1, Dept Infect Dis, Suzhou, Peoples R China

[5] Huazhong Univ Sci & Technol, Union Hosp, Tongji Med Coll, Dept Infect Dis, Wuhan, Peoples R China

[6] Tongde Hosp Zhejiang Prov, Key Lab Canc Prevent & Therapy Combining Tradit C, Hangzhou, Peoples R China

[7] Nanchang Univ, Affiliated Hosp 2, Dept Gastroenterol, Nanchang, Jiangxi, Peoples R China

[8] Anhui Med Univ, Affiliated Hosp 1, Dept Infect Dis, Hefei, Peoples R China

[9] Hebei North Univ, Grad Sch, Zhangjiakou, Peoples R China

[10] Zhejiang Univ, Sch Med, Affiliated Hosp 1, Dept Radiat Oncol, Hangzhou, Peoples R China

[11] Zhejiang Univ, Sch Med, Inst Pharmaceut Biotechnol, Hangzhou, Peoples R China

[12] Zhejiang Univ, Joint Inst Genet & Genome Med, Hangzhou, Peoples R China

[13] Univ Toronto, Hangzhou, Peoples R China

来源：

JOURNAL OF HEPATOLOGY | 2021年 / 75卷 / 05期

基金：

中国国家自然科学基金;

关键词：

ACLF; HBV; prognostic score; probability density function; risk stratification; MORTALITY; MODEL; DISEASE;

D O I：

10.1016/j.jhep.2021.05.026

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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 (=1.649xln(international normalized ratio)+0.457 xhepatic encephalopathy score+0.425xln(neutrophil)+0.396 xln(total bilirubin)+0.576xln(serum urea)+0.033xage). 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. (C) 2021 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.

引用

页码：1104 / 1115

页数：13

共 22 条

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