Prediction of the prognosis of patients with acute‐on‐chronic hepatitis B liver failure using the model for end‐stage liver disease scoring system and a novel logistic regression model

Abstract

The objective of this study was to determine the predictive value of the model for end-stage liver disease (MELD) scoring system in patients with acute-on-chronic hepatitis B liver failure (ACLF-HBV), and to establish a new model for predicting the prognosis of ACLF-HBV. A total of 204 adult patients with ACLF-HBV were retrospectively recruited between July 1, 2002 and December 31, 2004. The MELD scores were calculated according to the widely accepted formula. The 3-month mortality was calculated. The validity of the MELD model was determined by means of the concordance (c) statistic. Clinical data and biochemical values were included in the multivariate logistic regression analysis based on which the regression model for predicting prognosis was established. The receiver-operating characteristic curves were drawn for the MELD scoring system and the new regression model and the areas under the curves (AUC) were compared by the z-test. The 3-month mortality rate was 57.8%. The mean MELD score for the patients who died was significantly greater than those who survived beyond 3 months (28.7 vs 22.4, P = 0.003). The concordance (c) statistic (equivalent to the AUC) for the MELD scoring system predicting 3-month mortality was 0.709 (SE = 0.036, P < 0.001, 95% confidence interval 0.638-0.780). The independent factors predicting prognosis were hepatorenal syndrome (P < 0.001), liver cirrhosis (P = 0.009), HBeAg (P = 0.013), albumin (P = 0.028) and prothrombin activity (P = 0.011) as identified in multivariate logistic regression analysis. The regression model that was constructed by the logistic regression analysis produced a greater prognostic value (c = 0.891) than the MELD scoring system (z = 4.333, P < 0.001). The MELD scoring system is a promising and useful predictor for 3-month mortality of ACLF-HBV patients. Hepatorenal syndrome, liver cirrhosis, HBeAg, albumin and prothrombin activity are independent factors affecting the 3-month mortality. The newly established logistic regression model appears to be superior to the MELD scoring system in predicting 3-month mortality in patients with ACLF-HBV.

The Transforming Growth Factor β1/Interleukin-31 Pathway Is Upregulated in Patients with Hepatitis B Virus-Related Acute-on-Chronic Liver Failure and Is Associated with Disease Severity and Survival

“…The MELD score is a reliable measure of short-term mortality risk in patients with end-stage liver disease etiology and severity (20). There were significant positive correlations between the Child-Pugh score and the serum levels of TGF-␤1 (r ϭ 0.510; P ϭ 0.031), IL-31 (r ϭ 0.563; P ϭ 0.015), and IL-17 (r ϭ 0.496; P ϭ 0.036) in patients with ACLF, but there were no correlations between the MELD score and TGF-␤1 (r ϭ 0.284; P ϭ 0.254), IL-31 (r ϭ 0.238; P ϭ 0.341), and other cytokines ( Fig.…”

“…The severity of ACLF can be influenced by a number of factors, including age, HBeAg status, HBV DNA load, and the presence of underlying cirrhosis (20,22). Other factors might influence prognosis, such as sepsis, diabetes, and concurrent kidney disease.…”

“…Blood samples were collected on the next morning after admission from 17 CHB patients and 18 ACLF patients who were hospitalized or followed up from July 2012 to November 2013 in the Department of Infectious Diseases of The First Hospital of Quanzhou Affiliated to Fujian Medical University. The criteria for diagnoses of CHB and ACLF have been described in a previous study (20)(21)(22)(23)(24)(25). All CHB patients who had positive hepatitis B surface antigen detection (HBsAg) and hepatitis-related clinical manifestations or a histological confirmation of hepatitis and abnormal alanine aminotransferase (ALT) levels (Ͼ40 U/liter) for more than 6 months were included.…”

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

“…The most popular one seems to be that described by Sun et al [104]. The study was based on a retrospective review of 204 patients with ACHBLF, in whom the 3-month mortality was 57.8 %.…”

Expression of Human Glucocorticoid Receptor in T Lymphocytes in Acute-on-Chronic Hepatitis B Liver Failure

“…Moreover, jaundice and PTA are considered essential criteria for the diagnosis of acute-on-chronic liver failure. Although many new models have been established [23][24][25], MELD scoring system is still widely accepted and used in predicting prognosis of liver failure up to date. To confirm the association between GR expression and disease severity in ACHBLF patients, linear correlation analysis was performed.…”