A new multiparameter integrated MELD model for prognosis of HBV-related acute-on-chronic liver failure

Luo, Yue; Xu, Yun; Li, Mingming; Ya, Xie; Gong, Guozhong

doi:10.1097/md.0000000000004696

Cited by 10 publications

(7 citation statements)

References 26 publications

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“…The current study developed a novel online individual mortality risk predictive tool based on an RSF algorithm [35,36] age, [35,37,38] INR, [4,36,38,39] RDW, [40,41] AKI, [42][43][44] and serum sodium level. [45,46] The RSF algorithm could identify the variables that had a nonlinear effect on prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…The variable importance assessment through the RSF algorithm further proved HE, age, serum sodium level, AKI, RDW, and INR as risk factors for ACLF patients. Previous studies have provided strong clinical evidence for the following variables as risk factors for ACLF patients: HE, [35,36] age, [35,37,38] INR, [4,36,38,39] RDW, [40,41] AKI, [42–44] and serum sodium level [45,46] …”

Section: Discussionmentioning

confidence: 99%

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Individual mortality risk predictive system of patients with acute-on-chronic liver failure based on a random survival forest model

Zhang

Luo

et al. 2021

Chinese Medical Journal

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Individual mortality risk predictive system of patients with acute-on-chronic liver failure based on a random survival forest model

Zhang

Luo

et al. 2021

Chinese Medical Journal

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“…These findings suggested that patients with high AFP had greater regeneration activity and thus a better response to ALSS. Luo et al combined MELD with AFP, HE, WBC, and age to generate a new prognostic model to predict the prognosis of HBV‐ACLF patients. This model performed a higher AUROC than MELD, MELD‐Na, and iMELD.…”

Section: Discussionmentioning

confidence: 99%

A prognostic model for hepatitis B acute‐on‐chronic liver failure patients treated using a plasma exchange‐centered liver support system

Xie

Violetta

Chen

et al. 2019

J of Clinical Apheresis

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Aim: To determine the prognostic risk factors of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) treated with plasma exchange (PE)-based artificial liver support system (ALSS), and create a prognostic predictive model. Methods:A total of 304 HBV-ACLF patients who received PE-based ALSS were retrospectively analyzed. Potential prognostic factors on admission associated with survival were investigated. Of note, 101 additional patients were analyzed to validate the performance of the prognostic models.Results: According to 28-day survival, a total of 207 patients who survived and 97 non-survivors were identified in the derivation group. Overall, 268 (88.2%) ACLF cases were caused by reactivation of HBV. Cox proportional hazards regression model revealed that age, total bilirubin, ln (alphafetoprotein [AFP]), encephalopathy (HE) score, sodium level, and international normalized ratio (INR) were independent risk factors of short-term prognosis. We built a model named ALSS-prognosis model (APM) to predict the 28-day survival of HBV-ACLF patients with ALSS; the model APM showed potentially better predictive performance for both the derivation and validation groups than MELD, MELD-Na, and CLIF-C ACLF score.Conclusions: Low AFP was found to be an independent risk factor for high mortality in HBV-ACLF patients treated with PE-based ALSS. We generated a new model containing AFP, namely APM, which showed potentially better prediction performance than MELD, MELD-Na, and CLIF-C ACLF score for short-term outcomes, and could aid physicians in making optimal therapeutic decisions. K E Y W O R D S AFP, ALSS, HBV-ACLF, plasma exchange Zhongyang Xie and Laurencia Violetta contributed equally to this study.

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“…The maternal outcomes were also good in all cases. Although our study could not assess these prognostic scores, some good-quality studies have been conducted on them [ 34 , 35 ]. Very few studies have investigated whether these scoring systems are applicable to pregnant women.…”

Section: Discussionmentioning

confidence: 99%

Acute-on-Chronic Liver Failure in Pregnant Patients with Chronic Hepatitis B: A Retrospective Observational Case Series Study

Wang

Xiong

Luo

et al. 2020

Gastroenterology Research and Practice

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Background and Aims. Acute-on-chronic liver failure (ACLF) is common in patients with end-stage liver disease and chronic hepatitis B (CHB) or hepatitis B virus- (HBV-) related cirrhosis. To date, no uniform definition and management strategy are available for ACLF. Although a considerable number of studies on ACLF has been published, there are few reports on ACLF in pregnant women with CHB. This study retrospectively reviewed five patients who were diagnosed with ACLF during pregnancy in the past 10 years. We aimed at investigating their clinical characteristics, treatment, biochemical test results, and maternal and fetal outcomes. Results. Asthenia, anorexia, and jaundice were the main initial clinical manifestations in these patients during the second or third trimester of pregnancy. All patients received antiviral therapy. None of the pregnant women died after treatment. Patient #4 was treated with an artificial liver support system, and patients #2 and #5 underwent transfusion therapy. The acute insult in all patients was HBV DNA reactivation. Except for patient #3, who chose an actively induced vaginal delivery because of intrauterine fetal demise, the remaining four patients underwent a preterm delivery via a cesarean section. The four neonates were alive, although all were small for gestational age. Conclusion. Asthenia, anorexia, and jaundice during mid-late pregnancy should be immediately investigated. Before and during the pregnancy, hepatologists or obstetricians should actively screen pregnant women with CHB for HBV DNA status and alanine aminotransferase levels. Reactivation of HBV replication in pregnant women with CHB may lead to ACLF, especially in multiparous women. Once ACLF is diagnosed, antiviral therapy should be considered as soon as possible to protect maternal and fetal health.

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A new multiparameter integrated MELD model for prognosis of HBV-related acute-on-chronic liver failure

Abstract: Supplemental Digital Content is available in the text

Cited by 10 publications

References 26 publications

Individual mortality risk predictive system of patients with acute-on-chronic liver failure based on a random survival forest model

Individual mortality risk predictive system of patients with acute-on-chronic liver failure based on a random survival forest model

A prognostic model for hepatitis B acute‐on‐chronic liver failure patients treated using a plasma exchange‐centered liver support system

Acute-on-Chronic Liver Failure in Pregnant Patients with Chronic Hepatitis B: A Retrospective Observational Case Series Study

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