Predicting the Onset of Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Jinjin Luo; Xi Liang; Jiaojiao Xin; Jiaqi Li; Peng Li; Qian Zhou; Shaorui Hao; Huafen Zhang; Yingyan Lu; Tianzhou Wu; Lingling Yang; Jiang Li; Tan Li; Keke Ren; Beibei Guo; Xingping Zhou; Jiaxian Chen; Lulu He; Hui Yang; Wen Hu; Shaoli You; Shaojie Xin; Jing Jiang; Dongyan Shi; Xin Chen; Jun Li; Chinese Group on the Study of Severe Hepatitis B (COSSH)

doi:10.1016/j.cgh.2022.03.016

Predicting the Onset of Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Clin Gastroenterol Hepatol. 2023 Mar;21(3):681-693. doi: 10.1016/j.cgh.2022.03.016. Epub 2022 Mar 23.

Authors

Jinjin Luo¹, Xi Liang², Jiaojiao Xin¹, Jiaqi Li¹, Peng Li¹, Qian Zhou¹, Shaorui Hao¹, Huafen Zhang¹, Yingyan Lu³, Tianzhou Wu², Lingling Yang⁴, Jiang Li⁵, Tan Li¹, Keke Ren¹, Beibei Guo¹, Xingping Zhou¹, Jiaxian Chen¹, Lulu He¹, Hui Yang¹, Wen Hu¹, Shaoli You⁶, Shaojie Xin⁶, Jing Jiang⁷, Dongyan Shi⁸, Xin Chen⁹, Jun Li¹⁰; Chinese Group on the Study of Severe Hepatitis B (COSSH)

Affiliations

¹ State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
² Precision Medicine Center, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China.
³ Key Laboratory of Cancer Prevention and Therapy Combining Traditional Chinese and Western Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China.
⁴ Department of Gastroenterology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
⁵ Department of Infectious Disease, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
⁶ Senior Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
⁷ State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. Electronic address: jiangjingzju@zju.edu.cn.
⁸ State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. Electronic address: shidongyan@zju.edu.cn.
⁹ Institute of Pharmaceutical Biotechnology, Department of Radiation Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Joint Institute for Genetics and Genome Medicine, Zhejiang University and University of Toronto, Zhejiang University, Hangzhou, China. Electronic address: xinchen@zju.edu.cn.
¹⁰ State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. Electronic address: lijun2009@zju.edu.cn.

PMID: 35337983
DOI: 10.1016/j.cgh.2022.03.016

Abstract

Background & aims: Acute-on-chronic liver failure (ACLF) is a life-threatening syndrome with rapid progression. This study aimed to develop and validate a prognostic score to predict the onset of ACLF in hepatitis B virus (HBV) etiology.

Methods: The prospective clinical data of 1373 patients with acute deterioration of HBV-related chronic liver disease were used to identify clinical characteristics and develop a prognostic score for the onset of ACLF.

Results: Of the patients assessed using the Chinese Group on the Study of Severe Hepatitis B (COSSH)-ACLF criteria, 903 patients with non-ACLF at admission (1 received transplantation at 5 days) were stratified: 71 with progression to ACLF and 831 without progression to ACLF at 7 days. Four predictors (total bilirubin, international normalized ratio, alanine aminotransferase, and ferritin) were associated significantly with ACLF onset at 7 days. The COSSH-onset-ACLF score was constituted as follows: (0.101 × ln [alanine aminotransferase] + 0.819 × ln [total bilirubin] + 2.820 × ln [international normalized ratio] + 0.016 × ln [ferritin]). The C-indexes of the new score for 7-/14-/28-day onset (0.928/0.925/0.913) were significantly higher than those of 5 other scores (Chronic Liver Failure Consortium ACLF development score/Model for End-stage Liver Disease score/Model for End-stage Liver Disease sodium score/COSSH-ACLF score/Chronic liver failure Consortium ACLF score; all P < .001). The improvement in predictive errors, time-dependent receiver operating characteristic, probability density function evaluation, and calibration curves of the new score showed the highest predictive value for ACLF onset at 7/14/28 days. Risk stratification of the new score showed 2 strata with high and low risk (≥6.3/<6.3) of ACLF onset. The external validation group further confirmed the earlier results.

Conclusions: A new prognostic score based on 4 predictors can accurately predict the 7-/14-/28-day onset of ACLF in patients with acute deterioration of HBV-related chronic liver disease and might be used to guide clinical management.

Keywords: ACLF; C-Index; HBV; Prognostic Score.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acute-On-Chronic Liver Failure* / complications
Alanine Transaminase
Bilirubin
End Stage Liver Disease* / complications
Hepatitis B virus
Hepatitis B* / complications
Hepatitis B, Chronic* / complications
Humans
Prognosis
Prospective Studies
ROC Curve
Retrospective Studies
Severity of Illness Index

Substances

Alanine Transaminase
Bilirubin