Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure
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 patient...
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| Veröffentlicht in: | Journal of hepatology 2021-11, Vol.75 (5), p.1104-1115 |
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| creator | Li, Jiaqi Liang, Xi You, Shaoli Feng, Tingting Zhou, Xin Zhu, Bing Luo, Jinjin Xin, Jiaojiao Jiang, Jing Shi, Dongyan Lu, Yingyan Ren, Keke Wu, Tianzhou Yang, Lingling Li, Jiang Li, Tan Cai, Qun Sun, Suwan Guo, Beibei Zhou, Xingping Chen, Jiaxian He, Lulu Li, Peng Yang, Hui Hu, Wen An, Zhanglu Jin, Xiaojun Tian, Jin Wang, Baoju Chen, Xin Xin, Shaojie Li, Jun |
| description | 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.
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.
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 |
| doi_str_mv | 10.1016/j.jhep.2021.05.026 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2605661376</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0168827821003998</els_id><sourcerecordid>2605661376</sourcerecordid><originalsourceid>FETCH-LOGICAL-c428t-57da8216356df5a2cee10f169d571514ed728f4e9c1ae07a16d0c3fcec2405ba3</originalsourceid><addsrcrecordid>eNp9kMFu1DAQhi0EapfSF-CALHFOGDuxk0hcoC0tUiUucLZce0wdZe2t7QTx9ni1hSOnuXz_PzMfIW8ZtAyY_DC38yMeWg6ctSBa4PIF2TEJ0IDs2Uuyq9DYjHwYz8nrnGcA6GDqz8h518MEE5925OkaN1ziYY-hUB0s3fTirS4-Bhod1TTgL3pI8WeIuXhDs4kJqYuJ1tUVKz7Tz3Tzac1NwkUXtFSbtWATQ2MeUww1tPgNE3XaL2vCN-SV00vGy-d5QX58ufl-ddfcf7v9evXpvjE9H0sjBqtHzmQnpHVCc4PIwDE5WTEwwXq0Ax9dj5NhGmHQTFownTNoeA_iQXcX5P2pt17_tGIuao5rCnWl4hKElKwbZKX4iTIp5pzQqUPye51-KwbqaFnN6mhZHS0rEKparqF3z9Xrwx7tv8hfrRX4eAKwPrh5TCobj8Gg9QlNUTb6__X_AZt7j2M</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2605661376</pqid></control><display><type>article</type><title>Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure</title><source>MEDLINE</source><source>ScienceDirect Journals (5 years ago - present)</source><creator>Li, Jiaqi ; Liang, Xi ; You, Shaoli ; Feng, Tingting ; Zhou, Xin ; Zhu, Bing ; Luo, Jinjin ; Xin, Jiaojiao ; Jiang, Jing ; Shi, Dongyan ; Lu, Yingyan ; Ren, Keke ; Wu, Tianzhou ; Yang, Lingling ; Li, Jiang ; Li, Tan ; Cai, Qun ; Sun, Suwan ; Guo, Beibei ; Zhou, Xingping ; Chen, Jiaxian ; He, Lulu ; Li, Peng ; Yang, Hui ; Hu, Wen ; An, Zhanglu ; Jin, Xiaojun ; Tian, Jin ; Wang, Baoju ; Chen, Xin ; Xin, Shaojie ; Li, Jun</creator><creatorcontrib>Li, Jiaqi ; Liang, Xi ; You, Shaoli ; Feng, Tingting ; Zhou, Xin ; Zhu, Bing ; Luo, Jinjin ; Xin, Jiaojiao ; Jiang, Jing ; Shi, Dongyan ; Lu, Yingyan ; Ren, Keke ; Wu, Tianzhou ; Yang, Lingling ; Li, Jiang ; Li, Tan ; Cai, Qun ; Sun, Suwan ; Guo, Beibei ; Zhou, Xingping ; Chen, Jiaxian ; He, Lulu ; Li, Peng ; Yang, Hui ; Hu, Wen ; An, Zhanglu ; Jin, Xiaojun ; Tian, Jin ; Wang, Baoju ; Chen, Xin ; Xin, Shaojie ; Li, Jun ; Chinese Group on the Study of Severe Hepatitis B (COSSH)</creatorcontrib><description>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.
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.
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 showed the highest predictive values for mortality. These results were then validated in an external cohort.
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.
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.
[Display omitted]
•We developed a new prognostic COSSH-ACLF II score based on 6 predictors from a large cohort.•This score simplifies triage and can be used to stratify patients with HBV-ACLF based on their short-term mortality risk.•The new score has improved prognostic accuracy and sensitivity for patients with HBV-ACLF.•This score could be used to guide clinical management and reduce the currently unacceptable mortality rate.</description><identifier>ISSN: 0168-8278</identifier><identifier>EISSN: 1600-0641</identifier><identifier>DOI: 10.1016/j.jhep.2021.05.026</identifier><identifier>PMID: 34090929</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>ACLF ; Acute-On-Chronic Liver Failure - epidemiology ; Acute-On-Chronic Liver Failure - etiology ; Adult ; Bilirubin ; Cohort Studies ; Female ; HBV ; Hepatic encephalopathy ; Hepatitis B ; Hepatitis B - classification ; Hepatitis B - complications ; Hepatitis B - diagnosis ; Hepatitis B virus - metabolism ; Hepatitis B virus - pathogenicity ; Humans ; Leukocytes (neutrophilic) ; Liver ; Liver failure ; Male ; Middle Aged ; Mortality ; Patients ; probability density function ; Prognosis ; prognostic score ; Prospective Studies ; Research Design - standards ; Research Design - statistics & numerical data ; Retrospective Studies ; risk stratification ; ROC Curve ; Statistics, Nonparametric ; Viruses</subject><ispartof>Journal of hepatology, 2021-11, Vol.75 (5), p.1104-1115</ispartof><rights>2021 The Author(s)</rights><rights>Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. Nov 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-57da8216356df5a2cee10f169d571514ed728f4e9c1ae07a16d0c3fcec2405ba3</citedby><cites>FETCH-LOGICAL-c428t-57da8216356df5a2cee10f169d571514ed728f4e9c1ae07a16d0c3fcec2405ba3</cites><orcidid>0000-0001-6942-570X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jhep.2021.05.026$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34090929$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Jiaqi</creatorcontrib><creatorcontrib>Liang, Xi</creatorcontrib><creatorcontrib>You, Shaoli</creatorcontrib><creatorcontrib>Feng, Tingting</creatorcontrib><creatorcontrib>Zhou, Xin</creatorcontrib><creatorcontrib>Zhu, Bing</creatorcontrib><creatorcontrib>Luo, Jinjin</creatorcontrib><creatorcontrib>Xin, Jiaojiao</creatorcontrib><creatorcontrib>Jiang, Jing</creatorcontrib><creatorcontrib>Shi, Dongyan</creatorcontrib><creatorcontrib>Lu, Yingyan</creatorcontrib><creatorcontrib>Ren, Keke</creatorcontrib><creatorcontrib>Wu, Tianzhou</creatorcontrib><creatorcontrib>Yang, Lingling</creatorcontrib><creatorcontrib>Li, Jiang</creatorcontrib><creatorcontrib>Li, Tan</creatorcontrib><creatorcontrib>Cai, Qun</creatorcontrib><creatorcontrib>Sun, Suwan</creatorcontrib><creatorcontrib>Guo, Beibei</creatorcontrib><creatorcontrib>Zhou, Xingping</creatorcontrib><creatorcontrib>Chen, Jiaxian</creatorcontrib><creatorcontrib>He, Lulu</creatorcontrib><creatorcontrib>Li, Peng</creatorcontrib><creatorcontrib>Yang, Hui</creatorcontrib><creatorcontrib>Hu, Wen</creatorcontrib><creatorcontrib>An, Zhanglu</creatorcontrib><creatorcontrib>Jin, Xiaojun</creatorcontrib><creatorcontrib>Tian, Jin</creatorcontrib><creatorcontrib>Wang, Baoju</creatorcontrib><creatorcontrib>Chen, Xin</creatorcontrib><creatorcontrib>Xin, Shaojie</creatorcontrib><creatorcontrib>Li, Jun</creatorcontrib><creatorcontrib>Chinese Group on the Study of Severe Hepatitis B (COSSH)</creatorcontrib><title>Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure</title><title>Journal of hepatology</title><addtitle>J Hepatol</addtitle><description>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.
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.
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 showed the highest predictive values for mortality. These results were then validated in an external cohort.
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.
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.
[Display omitted]
•We developed a new prognostic COSSH-ACLF II score based on 6 predictors from a large cohort.•This score simplifies triage and can be used to stratify patients with HBV-ACLF based on their short-term mortality risk.•The new score has improved prognostic accuracy and sensitivity for patients with HBV-ACLF.•This score could be used to guide clinical management and reduce the currently unacceptable mortality rate.</description><subject>ACLF</subject><subject>Acute-On-Chronic Liver Failure - epidemiology</subject><subject>Acute-On-Chronic Liver Failure - etiology</subject><subject>Adult</subject><subject>Bilirubin</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>HBV</subject><subject>Hepatic encephalopathy</subject><subject>Hepatitis B</subject><subject>Hepatitis B - classification</subject><subject>Hepatitis B - complications</subject><subject>Hepatitis B - diagnosis</subject><subject>Hepatitis B virus - metabolism</subject><subject>Hepatitis B virus - pathogenicity</subject><subject>Humans</subject><subject>Leukocytes (neutrophilic)</subject><subject>Liver</subject><subject>Liver failure</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patients</subject><subject>probability density function</subject><subject>Prognosis</subject><subject>prognostic score</subject><subject>Prospective Studies</subject><subject>Research Design - standards</subject><subject>Research Design - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>risk stratification</subject><subject>ROC Curve</subject><subject>Statistics, Nonparametric</subject><subject>Viruses</subject><issn>0168-8278</issn><issn>1600-0641</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMFu1DAQhi0EapfSF-CALHFOGDuxk0hcoC0tUiUucLZce0wdZe2t7QTx9ni1hSOnuXz_PzMfIW8ZtAyY_DC38yMeWg6ctSBa4PIF2TEJ0IDs2Uuyq9DYjHwYz8nrnGcA6GDqz8h518MEE5925OkaN1ziYY-hUB0s3fTirS4-Bhod1TTgL3pI8WeIuXhDs4kJqYuJ1tUVKz7Tz3Tzac1NwkUXtFSbtWATQ2MeUww1tPgNE3XaL2vCN-SV00vGy-d5QX58ufl-ddfcf7v9evXpvjE9H0sjBqtHzmQnpHVCc4PIwDE5WTEwwXq0Ax9dj5NhGmHQTFownTNoeA_iQXcX5P2pt17_tGIuao5rCnWl4hKElKwbZKX4iTIp5pzQqUPye51-KwbqaFnN6mhZHS0rEKparqF3z9Xrwx7tv8hfrRX4eAKwPrh5TCobj8Gg9QlNUTb6__X_AZt7j2M</recordid><startdate>202111</startdate><enddate>202111</enddate><creator>Li, Jiaqi</creator><creator>Liang, Xi</creator><creator>You, Shaoli</creator><creator>Feng, Tingting</creator><creator>Zhou, Xin</creator><creator>Zhu, Bing</creator><creator>Luo, Jinjin</creator><creator>Xin, Jiaojiao</creator><creator>Jiang, Jing</creator><creator>Shi, Dongyan</creator><creator>Lu, Yingyan</creator><creator>Ren, Keke</creator><creator>Wu, Tianzhou</creator><creator>Yang, Lingling</creator><creator>Li, Jiang</creator><creator>Li, Tan</creator><creator>Cai, Qun</creator><creator>Sun, Suwan</creator><creator>Guo, Beibei</creator><creator>Zhou, Xingping</creator><creator>Chen, Jiaxian</creator><creator>He, Lulu</creator><creator>Li, Peng</creator><creator>Yang, Hui</creator><creator>Hu, Wen</creator><creator>An, Zhanglu</creator><creator>Jin, Xiaojun</creator><creator>Tian, Jin</creator><creator>Wang, Baoju</creator><creator>Chen, Xin</creator><creator>Xin, Shaojie</creator><creator>Li, Jun</creator><general>Elsevier B.V</general><general>Elsevier Science Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><orcidid>https://orcid.org/0000-0001-6942-570X</orcidid></search><sort><creationdate>202111</creationdate><title>Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure</title><author>Li, Jiaqi ; Liang, Xi ; You, Shaoli ; Feng, Tingting ; Zhou, Xin ; Zhu, Bing ; Luo, Jinjin ; Xin, Jiaojiao ; Jiang, Jing ; Shi, Dongyan ; Lu, Yingyan ; Ren, Keke ; Wu, Tianzhou ; Yang, Lingling ; Li, Jiang ; Li, Tan ; Cai, Qun ; Sun, Suwan ; Guo, Beibei ; Zhou, Xingping ; Chen, Jiaxian ; He, Lulu ; Li, Peng ; Yang, Hui ; Hu, Wen ; An, Zhanglu ; Jin, Xiaojun ; Tian, Jin ; Wang, Baoju ; Chen, Xin ; Xin, Shaojie ; Li, Jun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-57da8216356df5a2cee10f169d571514ed728f4e9c1ae07a16d0c3fcec2405ba3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>ACLF</topic><topic>Acute-On-Chronic Liver Failure - epidemiology</topic><topic>Acute-On-Chronic Liver Failure - etiology</topic><topic>Adult</topic><topic>Bilirubin</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>HBV</topic><topic>Hepatic encephalopathy</topic><topic>Hepatitis B</topic><topic>Hepatitis B - classification</topic><topic>Hepatitis B - complications</topic><topic>Hepatitis B - diagnosis</topic><topic>Hepatitis B virus - metabolism</topic><topic>Hepatitis B virus - pathogenicity</topic><topic>Humans</topic><topic>Leukocytes (neutrophilic)</topic><topic>Liver</topic><topic>Liver failure</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Patients</topic><topic>probability density function</topic><topic>Prognosis</topic><topic>prognostic score</topic><topic>Prospective Studies</topic><topic>Research Design - standards</topic><topic>Research Design - statistics & numerical data</topic><topic>Retrospective Studies</topic><topic>risk stratification</topic><topic>ROC Curve</topic><topic>Statistics, Nonparametric</topic><topic>Viruses</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Jiaqi</creatorcontrib><creatorcontrib>Liang, Xi</creatorcontrib><creatorcontrib>You, Shaoli</creatorcontrib><creatorcontrib>Feng, Tingting</creatorcontrib><creatorcontrib>Zhou, Xin</creatorcontrib><creatorcontrib>Zhu, Bing</creatorcontrib><creatorcontrib>Luo, Jinjin</creatorcontrib><creatorcontrib>Xin, Jiaojiao</creatorcontrib><creatorcontrib>Jiang, Jing</creatorcontrib><creatorcontrib>Shi, Dongyan</creatorcontrib><creatorcontrib>Lu, Yingyan</creatorcontrib><creatorcontrib>Ren, Keke</creatorcontrib><creatorcontrib>Wu, Tianzhou</creatorcontrib><creatorcontrib>Yang, Lingling</creatorcontrib><creatorcontrib>Li, Jiang</creatorcontrib><creatorcontrib>Li, Tan</creatorcontrib><creatorcontrib>Cai, Qun</creatorcontrib><creatorcontrib>Sun, Suwan</creatorcontrib><creatorcontrib>Guo, Beibei</creatorcontrib><creatorcontrib>Zhou, Xingping</creatorcontrib><creatorcontrib>Chen, Jiaxian</creatorcontrib><creatorcontrib>He, Lulu</creatorcontrib><creatorcontrib>Li, Peng</creatorcontrib><creatorcontrib>Yang, Hui</creatorcontrib><creatorcontrib>Hu, Wen</creatorcontrib><creatorcontrib>An, Zhanglu</creatorcontrib><creatorcontrib>Jin, Xiaojun</creatorcontrib><creatorcontrib>Tian, Jin</creatorcontrib><creatorcontrib>Wang, Baoju</creatorcontrib><creatorcontrib>Chen, Xin</creatorcontrib><creatorcontrib>Xin, Shaojie</creatorcontrib><creatorcontrib>Li, Jun</creatorcontrib><creatorcontrib>Chinese Group on the Study of Severe Hepatitis B (COSSH)</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><jtitle>Journal of hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Jiaqi</au><au>Liang, Xi</au><au>You, Shaoli</au><au>Feng, Tingting</au><au>Zhou, Xin</au><au>Zhu, Bing</au><au>Luo, Jinjin</au><au>Xin, Jiaojiao</au><au>Jiang, Jing</au><au>Shi, Dongyan</au><au>Lu, Yingyan</au><au>Ren, Keke</au><au>Wu, Tianzhou</au><au>Yang, Lingling</au><au>Li, Jiang</au><au>Li, Tan</au><au>Cai, Qun</au><au>Sun, Suwan</au><au>Guo, Beibei</au><au>Zhou, Xingping</au><au>Chen, Jiaxian</au><au>He, Lulu</au><au>Li, Peng</au><au>Yang, Hui</au><au>Hu, Wen</au><au>An, Zhanglu</au><au>Jin, Xiaojun</au><au>Tian, Jin</au><au>Wang, Baoju</au><au>Chen, Xin</au><au>Xin, Shaojie</au><au>Li, Jun</au><aucorp>Chinese Group on the Study of Severe Hepatitis B (COSSH)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure</atitle><jtitle>Journal of hepatology</jtitle><addtitle>J Hepatol</addtitle><date>2021-11</date><risdate>2021</risdate><volume>75</volume><issue>5</issue><spage>1104</spage><epage>1115</epage><pages>1104-1115</pages><issn>0168-8278</issn><eissn>1600-0641</eissn><abstract>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.
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.
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 showed the highest predictive values for mortality. These results were then validated in an external cohort.
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.
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.
[Display omitted]
•We developed a new prognostic COSSH-ACLF II score based on 6 predictors from a large cohort.•This score simplifies triage and can be used to stratify patients with HBV-ACLF based on their short-term mortality risk.•The new score has improved prognostic accuracy and sensitivity for patients with HBV-ACLF.•This score could be used to guide clinical management and reduce the currently unacceptable mortality rate.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>34090929</pmid><doi>10.1016/j.jhep.2021.05.026</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0001-6942-570X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0168-8278 |
| ispartof | Journal of hepatology, 2021-11, Vol.75 (5), p.1104-1115 |
| issn | 0168-8278 1600-0641 |
| language | eng |
| recordid | cdi_proquest_journals_2605661376 |
| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | ACLF Acute-On-Chronic Liver Failure - epidemiology Acute-On-Chronic Liver Failure - etiology Adult Bilirubin Cohort Studies Female HBV Hepatic encephalopathy Hepatitis B Hepatitis B - classification Hepatitis B - complications Hepatitis B - diagnosis Hepatitis B virus - metabolism Hepatitis B virus - pathogenicity Humans Leukocytes (neutrophilic) Liver Liver failure Male Middle Aged Mortality Patients probability density function Prognosis prognostic score Prospective Studies Research Design - standards Research Design - statistics & numerical data Retrospective Studies risk stratification ROC Curve Statistics, Nonparametric Viruses |
| title | Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-12T01%3A45%3A01IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Development%20and%20validation%20of%20a%20new%20prognostic%20score%20for%20hepatitis%20B%20virus-related%20acute-on-chronic%20liver%20failure&rft.jtitle=Journal%20of%20hepatology&rft.au=Li,%20Jiaqi&rft.aucorp=Chinese%20Group%20on%20the%20Study%20of%20Severe%20Hepatitis%20B%20(COSSH)&rft.date=2021-11&rft.volume=75&rft.issue=5&rft.spage=1104&rft.epage=1115&rft.pages=1104-1115&rft.issn=0168-8278&rft.eissn=1600-0641&rft_id=info:doi/10.1016/j.jhep.2021.05.026&rft_dat=%3Cproquest_cross%3E2605661376%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2605661376&rft_id=info:pmid/34090929&rft_els_id=S0168827821003998&rfr_iscdi=true |