Development and validation of a scoring system to predict progression to acute‐on‐chronic liver failure in patients with acute exacerbation of chronic hepatitis B

Abstract

Aim The aim of this study was to develop and validate a scoring system to predict the progression to acute‐on‐chronic liver failure (ACLF) in patients with acute exacerbation (AE) of chronic hepatitis B (CHB). Methods The baseline characteristics of 474 patients with AE of CHB were retrospectively reviewed; 280 and 194 patients were randomly assigned to the derivation and validation cohorts, respectively. Univariate risk factors associated with ACLF development were entered into a multivariate logistic regression. The score model was established, and its predictive value was evaluated by the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUROC). Results Hepatitis B virus (HBV) DNA, international normalized ratio (INR) of prothrombin time, and patient age were identified as independent risk factors associated with progressing to ACLF. The prediction model was established as R = −13.323 + 0.553 × log HBV‐DNA (copies/mL) + 3.631× INR + 0.053 × age. The AUROCs of our prediction model were higher than those of the Model for End‐stage Liver Disease (MELD) and MELD‐sodium (Na) for both cohorts. At the cut‐off value of −2.43, our prediction model had higher sensitivity (87.5%), specificity (73.6%), positive predictive value (23.0%), positive likelihood ratio (3.30), and lower negative likelihood ratio (0.17) in the validation cohort than those of MELD and MELD‐Na. Conclusion The independent risk factors associated with progressing to ACLF in patients with AE of CHB are HBV‐DNA, INR, and age. Our risk prediction model is useful for predicting the development of ACLF.

Risk factors for progression to acute-on-chronic liver failure during severe acute exacerbation of chronic hepatitis B virus infection

“…Several risk factors for post-admission development of ACLF in patients with SAE were different from those in patients with AE. In our previous study, LC was not an independent factor associated with the development of ACLF in patients with AE[19]. In this study, however, LC was an independent risk factor for post-admission progression of both HD and ACLF in patients with SAE.…”

“…Forty-three (26.2%) patients had progression to HD and 29 (17.7%) patients had progression to ACLF within 28 d of admission. Therefore, the patients in this study had more serious liver injury than patients with AE as previously reported (only 7.59% of patients had progression to ACLF)[19]. We found that LC was an independent risk factor associated with progression to both HD and ACLF, while high MELD score, high AST, and low PTA were independent risk factors associated with progression to ACLF.…”

“…In addition, the model for end-stage liver disease (MELD) score was calculated according to the following formula: MELD score = 3.78 × ln[TBil (mg/dL)] + 11.2 × ln(INR) + 9.57 × ln[Cr (mg/dL)] + 6.43 × (constant for liver disease etiology = 0, if cholestatic or alcoholic, otherwise = 1). The AE model was calculated as R = -13.323 + 0.553 × log HBV DNA (copies/mL) + 3.631 × INR + 0.053 × age (years)[19].…”

“…In a previous study, we assessed risk factors in patients with AE of chronic HBV infection, wherein AE was defined as alanine transaminase (ALT) > 5 × upper limits of normal (ULN), total bilirubin (TBil) ≥ 5 × ULN, and prothrombin time activity (PTA) of 40%-60%. We found that baseline age, HBV DNA, and international normalized ratio (INR) levels were independent factors related to the development of ACLF[19]. Based on this study, we established an AE model to predict the progression to ACLF in patients with AE.…”

Autotaxin: An Early Warning Biomarker for Acute-on-chronic Liver Failure

“…ACLF is a static diagnosis for liver function status, which is diagnosed until the appearance of acute deterioration of liver function with the progression of disease. 21 With the dynamic development of disease, severe CHB patients may not develop liver failure and instead experience a gradually restoration of function, but the status may also may further aggravate to liver failure and lead to diagnosis of ACLF. Thus, in the early phase of acute exacerbation of CHB, prediction of the risk of the occurrence of ACLF, timely prevention, intervention and standardized treatment to prevent its progression to ACLF will no doubt improve the prognosis of patients.…”