CHINAT-CD4 Score Predicts Transplant-Free Survival in Patients with Acute-on-Chronic Liver Failure

Chenlu Huang; Weixia Li; Chong Chen; Wei Xu; Ling Fei; Shuai Tao; Qiankun Hu; Xudong Xie; Xiongyue Cao; Xiao-Yu Zhang; Liang Chen; Qiang Li; Yuxian Huang

doi:10.2147/JIR.S389789

CHINAT-CD4 Score Predicts Transplant-Free Survival in Patients with Acute-on-Chronic Liver Failure

J Inflamm Res. 2023 Jan 13:16:197-207. doi: 10.2147/JIR.S389789. eCollection 2023.

Authors

Chenlu Huang^#¹, Weixia Li^#², Chong Chen^#², Wei Xu¹, Ling Fei¹, Shuai Tao³, Qiankun Hu¹, Xudong Xie¹, Xiongyue Cao¹, Xiao-Yu Zhang^{1

4}, Liang Chen¹, Qiang Li¹, Yuxian Huang¹

Affiliations

¹ Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of China.
² Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of China.
³ Research Unit, Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of China.
⁴ Section of Education, Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of China.

^# Contributed equally.

Abstract

Aim: The early prognosis evaluation of acute-on-chronic liver failure (ACLF) is important to decrease its mortality. We aimed to develop a new score to accurately predict the outcome of patients with ACLF.

Methods: A derivation set of 408 patients with hepatitis B virus-related ACLF (HBV-ACLF) based on the Asian Pacific Association for the Study of the Liver criteria is used to develop a prognostic score that was validated in 209 patients with HBV-ACLF and 195 patients with non-HBV-ACLF.

Results: Seven factors were significantly related to the 28-day mortality and constituted a new score (CHINAT-CD4 = 0.320 × ln (creatinine) + 0.668 × hepatic encephalopathy score + 0.745 × ln (international normalized ratio) + 0.476 × ln (neutrophil) + 0.251 × ln (aspartate aminotransferase) + 0.411 × ln (total bilirubin) - 0.605 × ln (CD4+ T cells count)). The C-indices of the new score for the 28-/90-day mortality (0.810/0.806) outperformed those of the other seven scores (p≤0.05). The results were confirmed in a validation set (0.798/793 for HBV-ACLF; 0.790/0.788 for non-HBV-ACLF). The novel score based on CD4⁺ T cell count showed high predictive performance for the 28-/90-day mortality of ACLF.

Conclusion: The novel score based on CD4⁺ T cell count can accurately predict the 28-/90-day mortality for patients with ACLF.

Keywords: chronic liver disease; inflammatory markers; liver failure; prognostic score; risk stratification.

Grants and funding

This study was supported by the ShenKang development center of Shanghai (SHDC12020109), the science and technology commission of Shanghai (21S11905600) and the Shanghai Municipal Health Commission(2022YQ027). The funding organizations are public institutions and had no role in the design and conduct of the study; collection, management, and analysis of the data; or preparation, review, and approval of the manuscript.