Analysis of prognostic risk factors and establishment of prognosis model in patients with hepatitis B virus-related acute-on-chronic liver failure / 中华传染病杂志

ABSTRACT

Objective To explore the risk factors for prognosis in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF),and to establish a prognostic model.Methods A total of 193 patients diagnosed with HBV-ACLF who were admitted to the Department of Infectious Diseases of the Third Hospital of Hebei Medical University were collected from 1st January 2013 to 1st November 2018 as a derivation cohort.Thirty-five patients diagnosed with HBV-ACLF who were admitted to the Fifth Hospital of Shijiazhuang during the period from 1st July 2017 to 1st November 2018 were collected as a validation cohort.The survival condition of all patients at week 12 of admission was observed.The risk factors associated with short-term prognosis were analyzed by using multivariate logistic regression analysis,and a logistic regression equation prediction model was established and verified.The diagnostic performance of the prognostic model was evaluated using the receiver operating characteristic (ROC) curve,and was compared with model for end-stage liver disease (MELD) scoring system,Child-Turcotte-Pugh (CTP) scoring system,sequential organ failure assessment (SOFA) scoring system and chronic liver failure (CLIF)-SOFA scoring system.Results Multivariate logistic regression analysis showed that age (odds ratio (OR) =2.133,95％ confidence interval (CI) 1.033-4.405),total bilirubin (OR =3.37 1,95％CI 1.610-7.060),serum creatinine (OR =4.448,95％C1 1.697-11.661),hepatic encephalopathy (OR =5.313,95％CI2.463-11.461),and ascites (OR =2.959,95％CI 1.410-6.210) were independent risk factors for predicting the short-term prognosis of patients with HBV-ACLF.The newly established logistic regression model (LRM) =-1.726 + 0.757 × age + 1.215 × total bilirubin + 1.049 2 × serum creatinine + 1.670 × hepatic encephalopathy (with =1,without =0) + 1.085 × ascites (with =1,without =0).The area under the ROC curve of the LRM for predicting the short-term prognosis of patients with HBV-ACLF was 0.82 (95％CI0.76-0.88).Furthermore,the areas under the ROC curve of the models of MELD,CTP,SOFA,CLIF-SOFA were 0.67 (95％CI 0.60-0.75),0.73 (95％CI 0.66-0.80),0.77 (95％CI 0.70-0.83) and 0.72 (95％CI 0.65-0.80),respectively.The ROC-area under curve of the validation cohort was 0.81 (95％CI0.65-0.97).Conclusions Age,total bilirubin,serum creatinine,hepatic encephalopathy,and ascites are independent risk factors for the prognosis of HBV-ACLF.The prognostic model established based on these factors can accurately predict the patients' short-term prognosis,which is superior to M ELD,CTP,SOFA and C LIF-SOFA.