DIC Score Combined With CLIF-C OF Score Is More Effective in Predicting Prognosis in Patients With Hepatitis B Virus Acute-on-Chronic Liver Failure

Xueyun Zhang; Jiajia Han; Xun Qi; Yao Zhang; Pu Zhou; Xiaoqin Liu; Yue Ying; Wenhong Zhang; Jiming Zhang; Yuxian Huang

doi:10.3389/fmed.2022.815580

DIC Score Combined With CLIF-C OF Score Is More Effective in Predicting Prognosis in Patients With Hepatitis B Virus Acute-on-Chronic Liver Failure

Front Med (Lausanne). 2022 Feb 11:9:815580. doi: 10.3389/fmed.2022.815580. eCollection 2022.

Authors

Xueyun Zhang¹, Jiajia Han¹, Xun Qi², Yao Zhang¹, Pu Zhou³, Xiaoqin Liu¹, Yue Ying¹, Wenhong Zhang¹, Jiming Zhang^{1

4

5}, Yuxian Huang^{1

2}

Affiliations

¹ Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
² Department of Hepatology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
³ Huashan Worldwide Medical Center, Huashan Hospital, Fudan University, Shanghai, China.
⁴ Key Laboratory of Medical Molecular Virology (MOE/MOH), Shanghai Institute of Infectious Diseases and Biosecurity, Shanghai Medical College, Fudan University, Shanghai, China.
⁵ Department of Infectious Diseases, Jing'an Branch of Huashan Hospital, Fudan University, Shanghai, China.

Abstract

Coagulation and fibrinolysis disorders are major prognostic factors in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients. Here, we aimed to clarify the role of disseminated intravascular coagulation (DIC) scores in predicting HBV-ACLF patient prognosis. We assessed the DIC score from HBV-ACLF patients at Huashan Hospital in Shanghai, China from June 2013 to May 2021 and evaluated it in relation to short-term mortality, clinical course, and infection. A novel prognostic scoring model was proposed based on DIC scores. A total of 163 transplant-free HBV-ACLF patients were enrolled. DIC scores were higher in non-survivors than survivors (6 vs. 4, P = 0.000) and were independently associated with short-term mortality [hazard ratio (HR): 1.397, 95% confidence interval (95% CI): 1.040-1.875, P = 0.026]. DIC scores were associated with ACLF grade, clinical course, and infection. Moreover, they were correlated with model for end-stage liver disease (MELD) scores (r = 0.521, P < 0.001). The area under the receiver operating curve (auROC) of CLIF-C OF-DICs [a novel prognostic score based on age, DIC score, and Chronic liver failure-consortium organ function score (CLIF-C OFs)] for 90-day mortality was 0.936, which was higher than six other generic prognostic scoring models. These results were confirmed in a validation cohort (n = 82). In conclusion, elevated DIC score is associated with poor prognosis in HBV-ACLF patients, and can be used jointly with CLIF-C OFs to improve the accuracy of prognosis prediction.

Keywords: DIC score; acute-on-chronic liver failure; coagulation; prognosis; prognostic score.