Modified model for end-stage liver disease improves short-term prognosis of hepatitis B virus-related acute-on-chronic liver failure

Abstract

AIMTo investigate whether the short-term prognosis of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) could be improved by using a modified model for end-stage liver disease (MELD) including serum lactate.METHODSThis clinical study was conducted at the First Affiliated Hospital, Fujian Medicine University, China. From 2009 to 2015, 236 patients diagnosed with HBV-related ACLF at our center were recruited for this 3-month follow-up study. Demographic data and serum lactate levels were collected from the patients. The MELD scores with or without serum lactate levels from survival and non-survival groups were recorded and compared.RESULTSTwo hundred and thirty-six patients with HBV-ACLF were divided into two groups: survival group (S) and non-survival group (NS). Compared with the NS group, the patients in survival the S group had a significantly lower level of serum lactate (3.11 ± 1.98 vs 4.67 ± 2.43, t = 5.43, P < 0.001) and MELD score (23.33 ± 5.42 vs 30.37 ± 6.58, t = 9.01, P = 0.023). Furthermore, serum lactate level was positively correlated with MELD score (r = 0.315, P < 0.001). Therefore, a modified MELD including serum lactate was developed by logistic regression analysis (0.314 × lactate + 0.172 × MELD - 5.923). In predicting 3-month mortality using the MELD-LAC model, the patients from the S group had significantly lower baseline scores (-0.930 ± 1.34) when compared with those from the NS group (0.771 ± 1.32, t = 9.735, P < 0.001). The area under the receiver operating characteristic curve (AUROC) was 0.859 calculated by using the MELD-LAC model, which was significantly higher than that calculated by using the lactate level (0.790) or MELD alone (0.818). When the cutoff value was set at -0.4741, the sensitivity, specificity, positive predictive value and negative predictive value for predicting short-term mortality were 91.5%, 80.10%, 94.34% and 74.62%, respectively. When the MELD-LAC scores at baseline level were set at -0.5561 and 0.6879, the corresponding mortality rates within three months were 75% and 90%, respectively.CONCLUSIONThe short-term prognosis of HBV-related ACLF was improved by using a modified MELD including serum lactate from the present 6-year clinical study.

Risk factors and prognostic model for HBV-related subacute liver failure

“…For example, Xun et al found that the AUC of the MELD score in 77 patients with HBV-related subacute liver failure was only 0.72 (11). Follow-up studies have shown that improving this MELD scoring system based on the MELD score can better predict the prognosis of patients with liver failure (12)(13)(14). In this study, we found that although the MELD score was helpful in distinguishing the risk of death in patients with subacute liver failure, its efficacy and sensitivity were significantly lower than the model constructed in this study, which again indicates that the model constructed in this study may be more suitable for domestic patients with subacute liver failure.…”

Low high-density lipoprotein cholesterol levels predicting poor outcomes in patients with hepatitis B virus-related acute-on-chronic liver failure

“…Numerous risk score models have been reported to predict poor outcomes in patients with ACLF, such as the Child-Turcotte-Pugh (CTP) score, Model for End-Stage Liver Disease (MELD) score, and Chinese Group on the Study of Severe Hepatitis B-ACLF (COSSH-ACLF) II score (3)(4)(5). However, there are some limitations between these score models.…”

Artificial liver support systems for hepatitis B virus‐associated acute‐on‐chronic liver failure: A meta‐analysis of the clinical literature

“…In this subgroup analysis, we also reported that age and TBIL levels were independent predictors of 1‐month mortality among HBV‐ACLF patients. Meanwhile, MELD scores were an independent risk factor for 3‐month mortality for HBV‐ACLF patients 30 …”

“…Meanwhile, MELD scores were an independent risk factor for 3-month mortality for HBV-ACLF patients. 30 In addition, many factors, including blood flow rates, surface, pore size and placement of filters, material, amount and active surface of absorbers, as well as albumin concentration and flow rates in the plasma circuits, influenced the detoxifying efficiency of the various ALSS, which may explain the discrepancy among various studies. 23 Our study also has some limitations.…”