Establishment of clinical features and prognostic scoring model in early-stage hepatitis B-related acute-on-chronic liver failure
- VernacularTitle:乙型肝炎慢加急性肝衰竭前期的临床特征及预后评分模型的建立
- Author:
Tianzhou WU
1
;
Xi LIANG
;
Jiaqi LI
;
Tan LI
;
Lingling YANG
;
Jiang LI
;
Jiaojiao XIN
;
Jing JIANG
;
Dongyan SHI
;
Keke REN
;
Shaorui HAO
;
Linfeng JIN
;
Ping YE
;
Jianrong HUANG
;
Xiaowei XU
;
Zhiliang GAO
;
Zhongping DUAN
;
Tao HAN
;
Yuming WANG
;
Baoju WANG
;
Jianhe GAN
;
Tingting FEN
;
Chen PAN
;
Yongping CHEN
;
Yan HUANG
;
Qing XIE
;
Shumei LIN
;
Xin CHEN
;
Shaojie XIN
;
Lanjuan LI
;
Jun LI
Author Information
- Keywords: Hepatitis B; Acute-on-chronic hepatic dysfunction; Prognostic score
- From: Chinese Journal of Hepatology 2020;28(4):310-318
- CountryChina
- Language:Chinese
- Abstract: Objective:To explore the clinical characteristics and establish a corresponding prognostic scoring model in patients with early-stage clinical features of hepatitis B-induced acute-on-chronic liver failure (HBV-ACLF).Methods:Clinical characteristics of 725 cases with hepatitis B-related acute-on-chronic hepatic dysfunction (HBV-ACHD) were retrospectively analyzed using Chinese group on the study of severe hepatitis B (COSSH). The independent risk factors associated with 90-day prognosis to establish a prognostic scoring model was analyzed by multivariate Cox regression, and was validated by 500 internal and 390 external HBV-ACHD patients.Results:Among 725 cases with HBV-ACHD, 76.8% were male, 96.8% had cirrhosis base,66.5% had complications of ascites, 4.1% had coagulation failure in respect to organ failure, and 9.2% had 90-day mortality rate. Multivariate Cox regression analysis showed that TBil, WBC and ALP were the best predictors of 90-day mortality rate in HBV-ACHD patients. The established scoring model was COSS-HACHADs = 0.75 × ln(WBC) + 0.57 × ln(TBil)-0.94 × ln(ALP) +10. The area under the receiver operating characteristic curve (AUROC) of subjects was significantly higher than MELD, MELD-Na, CTP and CLIF-C ADs( P < 0.05). An analysis of 500 and 390 cases of internal random selection group and external group had similar verified results. Conclusion:HBV-ACHD patients are a group of people with decompensated cirrhosis combined with small number of organ failure, and the 90-day mortality rate is 9.2%. COSSH-ACHDs have a higher predictive effect on HBV-ACHD patients' 90-day prognosis, and thus provide evidence-based medicine for early clinical diagnosis and treatment.
