A dynamic prediction model for prognosis of acute-on-chronic liver failure based on the trend of clinical indicators

Abstract

Acute-on-chronic liver failure (ACLF) is a dynamic syndrome, and sequential assessments can reflect its prognosis more accurately. Our aim was to build and validate a new scoring system to predict short-term prognosis using baseline and dynamic data in ACLF. We conducted a retrospective cohort analysis of patients with ACLF from three different hospitals in China. To construct the model, we analyzed a training set of 541 patients from two hospitals. The model’s performance was evaluated in a validation set of 130 patients from another center. In the training set, multivariate Cox regression analysis revealed that age, WGO type, basic etiology, total bilirubin, creatinine, prothrombin activity, and hepatic encephalopathy stage were all independent prognostic factors in ACLF. We designed a dynamic trend score table based on the changing trends of these indicators. Furthermore, a logistic prediction model (DP-ACLF) was constructed by combining the sum of dynamic trend scores and baseline prognostic parameters. All prognostic scores were calculated based on the clinical data of patients at the third day, first week, and second week after admission, respectively, and were correlated with the 90-day prognosis by ROC analysis. Comparative analysis showed that the AUC value for DP-ACLF was higher than for other prognostic scores, including Child–Turcotte–Pugh, MELD, MELD-Na, CLIF-SOFA, CLIF-C ACLF, and COSSH-ACLF. The new scoring model, which combined baseline characteristics and dynamic changes in clinical indicators to predict the course of ACLF, showed a better prognostic ability than current scoring systems. Prospective studies are needed to validate these results.

Pathological Significance and Prognostic Roles of Indirect Bilirubin/Albumin Ratio in Hepatic Encephalopathy

“…Other risk factors we demonstrated are no different from previous studies. Lower hemoglobin and PTA levels have been shown to be associated with HE or liver failure ( 34 , 35 ). Systemic inflammation is common in liver failure.…”

Impact of Hepatic Encephalopathy on Clinical Characteristics and Adverse Outcomes in Prospective and Multicenter Cohorts of Patients With Acute-on-Chronic Liver Diseases

“…Every Model is adjusted stepwise to further demonstrate the influence of these parameters on adverse outcome. Model IV is adjusted based on model III plus the parameters with clinical significance as indicated in other study, like TB, INR and Cr ( 18 ). The survival rates in patients with different HE grades were estimated using the Kaplan–Meier method.…”

“…Association of HE grade with characteristics of AoCLD patients.on model III plus the parameters with clinical significance as indicated in other study, like TB, INR and Cr(18). The survival rates in patients with different HE grades were estimated using the Kaplan-Meier method.…”

Wenyang Huazhuo Tuihuang Formula Inhibits the Th17/Treg Cell Imbalance and Protects against Acute-on-Chronic Liver Failure

“…In 2009, the Asia Pacific Association for the Study of the Liver (APASL) first defined the concept of ACLF. ACLF is an acute injury of liver function that occurs on the basis of chronic liver disease, and it is related to multiple organ failure and high mortality [ 5 – 7 ]. Therefore, new strategies to prevent the disease progression of liver failure are urgently required.…”