1.Establishment of clinical features and prognostic scoring model in early-stage hepatitis B-related acute-on-chronic liver failure
Tianzhou WU ; 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
Chinese Journal of Hepatology 2020;28(4):310-318
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.
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