ABC prognostic classification and MELD 3.0 and COSSH-ACLF Ⅱ prognostic evaluation in acute-on-chronic liver failure.
10.3760/cma.j.cn501113-20220308-00103
- VernacularTitle:慢加急性肝衰竭ABC分型的预后及MELD 3.0和COSSH-ACLF Ⅱ对预后评估
- Author:
Wan Shu LIU
1
;
Li Jun SHEN
1
;
Hua TIAN
1
;
Qing Hui ZHAI
1
;
Dong Ze LI
1
;
Fang Jiao SONG
1
;
Shao Jie XIN
1
;
Shao Li YOU
1
Author Information
1. Liver Disease Department, Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China.
- Publication Type:Journal Article
- MeSH:
Humans;
Acute-On-Chronic Liver Failure;
Prognosis;
End Stage Liver Disease/complications*;
Retrospective Studies;
Severity of Illness Index
- From:
Chinese Journal of Hepatology
2022;30(9):976-980
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To investigate the ABC prognostic classification and the updated version of Model for End-stage Liver Disease (MELD) score 3.0 and Chinese Group on the Study of Severe Hepatitis B ACLF Ⅱ score (COSSH-ACLF Ⅱ score) to evaluate the prognostic value in acute-on-chronic liver failure (ACLF). Methods: ABC classification was performed on a 1 409 follow-up cohorts. The area under the receiver operating characteristic curve (AUROC) was used to analyze MELD, MELD 3.0, COSSH-Ⅱ and COSSH-Ⅱ score after 3 days of hospitalization (COSSH-Ⅱ-3d). The prognostic predictive ability of patients were evaluated for 360 days, and the prediction differences of different classifications and different etiologies on the prognosis of ACLF were compared. Results: The survival curve of 1 409 cases with ACLF showed that the difference between class A, B, and C was statistically significant, Log Rank (Mantel-Cox) χ2=80.133, P<0.01. Compared with class A and C, χ2=76.198, P<0.01, the difference between class B and C, was not statistically significant χ2=3.717, P>0.05. AUROC [95% confidence interval (CI)] analyzed MELD, MELD 3.0, COSSH-Ⅱ and COSSH-Ⅱ-3d were 0.644, 0.655, 0.817 and 0.839, respectively (P<0.01). COSSH-Ⅱ had better prognostic predictive ability with class A ACLF and HBV-related ACLF (HBV-ACLF) for 360-days, and AUROC (95% CI) were 0.877 and 0.881, respectively (P<0.01), while MELD 3.0 prognostic predictive value was not better than MELD. Conclusion: ACLF prognosis is closely related to ABC classification. COSSH-Ⅱ score has a high predictive value for the prognostic evaluation of class A ACLF and HBV-ACLF. COSSH-Ⅱ score has a better prognostic evaluation value after 3 days of hospitalization, suggesting that attention should be paid to the treatment of ACLF in the early stage of admission.
