A nomogram to predict survival in patients with acute-on-chronic hepatitis B liver failure after liver transplantation

Chen, Liang; Zhang, Jiebin; Lu, Tian; Cai, Jianye; Zheng, Jun; Yao, Jia; Yi, Shuhong; Li, Hua; Chen, Guihua; Zhao, Hui; Zhang, Yingcai; Yang, Yang

doi:10.21037/atm-20-6180

Cited by 10 publications

(4 citation statements)

References 32 publications

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“…Several previous studies have evaluated factors associated with prognosis of HBV-ACLF patients following LT. For example, a study of 290 patients with ACLF after LT found that recipient WBC count, the ratio of alanine aminotransferase (ALT) to aspartate aminotransferase (AST), and the number of organs that failed were prognostic of survival [ 13 ]. Another study, of 78 patients, reported that patients with initial COSSH-ACLF grade 3 and with grades 2 and 3 on days 3–7 after diagnosis had poorer prognosis [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…At present, liver transplantation (LT) is the most effective treatment for patients with HBV-ACLF [ 8 – 12 ]. Although factors prognostic of LT in patients with ACLF have been widely reported, few studies to date have focused on HBV-related ACLF and assessed the post-LT prognosis of patients with HBV-ACLF; moreover, those studies included relatively small numbers of patients and did not completely evaluate indicators [ 12 , 13 ]. No studies to date have reported reliable and uniform prognostic factors that can predict survival outcomes in LT recipients who developed HBV-ACLF.…”

Section: Introductionmentioning

confidence: 99%

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Factors Prognostic of Survival in Liver Transplant Recipients with Hepatitis B Virus Related Acute-on-Chronic Liver Failure

Zhou

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Objectives. Factors prognostic of survival in liver transplant (LT) recipients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) remain unclear. This study evaluated risk factors for survival in LT recipients with HBV-ACLF and determined the scoring system optimal for assessing patient prognosis. Methods. This retrospective study included 323 HBV-ACLF related patients undergoing LT, including 112, 146, and 65 patients with HBV-ACLF grades 1, 2, and 3, respectively. Overall survival (OS) was estimated by the Kaplan–Meier method, and factors associated with survival were analysed by multivariate Cox proportional hazards models. Pretransplant prognostic scoring systems were compared by receiver operating characteristic (ROC) curve analysis. Results. The one-year survival rate was significantly lower in HBV-ACLF grade 3 (80.0%) than in grades 1 (93.8%) and 2 (91.8%) recipients ( p = 0.0063 ). Cox multivariate analysis showed that age >53 years (hazard ratio (HR) 3.731; 95% confidence interval (CI) 1.640–8.407), WBC count >8.6 × 109/L (HR 4.544; 95% CI 1.140–18.107), HBV-ACLF 3 (HR 2.729; 95% CI 1.050–7.096), and cold ischaemia time >8.5 hours (HR 2.867; 95% CI, 1.38–5.921) were independently prognostic of 1-year survival. Comparisons of pretransplant scoring systems showed that chronic liver failure-consortium ACLF score (CLIF-C ACLFs) was superior to COSSH-ACLF, MELD-Na, and MELD scores in predicting 1-year OS in these patients. Conclusions. Age >53 years, WBC counts >8.6 × 109/L, HBV-ACLF grade 3, and cold ischaemia time >8.5 hours are independently prognostic of OS in LT recipients with HBV-ACLF. CLIF-C ACLFs is superior to other scoring methods in predicting 1-year OS in these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors Prognostic of Survival in Liver Transplant Recipients with Hepatitis B Virus Related Acute-on-Chronic Liver Failure

Zhou

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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“…Acute-on-chronic liver failure (ACLF) is a severe clinical syndrome characterized by acute liver decompensation, organ failures, and a high rate of short-term mortality triggered by an acute insult. [1][2][3] In China, HBV-ACLF accounts for more than 70% of ACLF cases due to the high prevalence of HBV infection. 4,5 While liver transplantation (LT) is the definitive therapeutic option for liver failure, 6 the shortage of LT resources in China leads to an extremely poor prognosis for HBV-ACLF patients, with a high short-term mortality rate ranging from 29.7% to 40%.…”

Section: Introductionmentioning

confidence: 99%

Prealbumin as a Predictor of Short-Term Prognosis in Patients with HBV-Related Acute-on-Chronic Liver Failure

Zhang¹,

Yang²,

Wang³

et al. 2023

IDR

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Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a serious medical condition with a high short-term mortality rate, making accurate prognostic assessment essential for informed clinical decision-making. In this study, we aimed to develop a simple and effective prognostic model for predicting short-term mortality in patients with HBV-ACLF. Patients and Methods: To achieve our objective, we enrolled both a cross-sectional cohort (n = 291) and a retrospective cohort (n = 185) in this study. We collected laboratory and clinical data from these cohorts and performed univariate and multivariate logistic regression analyses to identify independent predictors of short-term mortality. Subsequently, we developed a novel prognostic score for HBV-ACLF, which was validated and assessed using receiver operating characteristic (ROC) curve analysis to determine its performance. Results: Our analysis revealed that the admission prealbumin (PAB) level was a robust independent predictor of 30-day mortality, with an area under the receiver operating characteristic (AUROC) of 0.760. Moreover, we developed the HIAPP score, a prognosticscore model based on PAB. The HIAPP score was significantly lower in survivors compared to non-survivors (−2.80±0.21 vs 0.97 ±0.41, P < 0.001). The HIAPP score's AUROC value was 0.899, which was found to be superior to the MELD score (AUROC = 0.795) and the CLIF-C ACLF score (AUC =0.781) and comparable to the COSSH-ACLF II score (AUC =0.825) for predicting 30-day mortality. These findings were also validated in a separate cohort, further supporting the utility of the HIAPP score as a prognostic tool for HBV-ACLF patients. Conclusion: Our study identifies the admission PAB level as a simple and valuable predictive index for 30-day mortality in HBV-ACLF patients. Furthermore, the HIAPP score, which incorporates PAB, PLT, INR, HE, and age, is an easy-to-use and pragmatic prognostic score in predicting short-term mortality.

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“…Consequently, a more finely-tuned approach for predicting personalized liver fibrosis and inflammatory responses of chronic HBV-infected patients is necessary. In recent years, nomograms have been emphasized in the prediction of HBV-related diseases, such as, in predicting survival in patients with acute-on-chronic HBV liver failure after liver transplantation ( 13 ), in assessing mortality in patients with acute and chronic HBV liver failure ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

Establishment and validation of a diagnostic nomogram for significant histopathologic changes of hepatic injury in HBV-infected patients

Sun¹,

Wang²,

Zhang³

et al. 2023

Ann Transl Med

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Background: Significant histopathologic changes of hepatic injury (SHCHI) play a decisive role in evaluating the condition and initiating antiviral in HBV-infected patients, especially those with normal or mildly elevated alanine transaminase levels. Considering that non-invasive methods were established through experience with chronic hepatitis C, the aim of this study was to establish and verify a nomogram based on hepatitis B for diagnosing SHCHI.Methods: Three hundred eighty-four patients who fulfilled requirements for participation were randomly assigned to training cohort (n=270) and validation cohort (n=114) according to 7:3. The selection criteria for clinical factors were based on the previous research papers. SHCHI was subgrouped as followed: grade ≥ G2 inflammation and/or stage ≥ S2 fibrosis. The predictive accuracy and discriminative ability of nomogram were determined by a concordance index (C-index), calibration curve and the area under the receiveroperating characteristic curve (AUROC). We also compared diagnostic value of nomogram with model for AST-to-PLT ratio index (APRI) score and model for Fibrosis-4 (FIB-4) score. Results: Two hundred and two patients (74.44%) and 87 patients (76.32%) were diagnosed as SHCHI, in the training and validation cohort. Logistic regression analysis illustrated that hepatitis B e antigen (HBeAg), aspartate aminotransferase (AST), γ-glutamyl transferase (GGT), and prothrombin time (PT) all independently served as risk factors for SHCHI (P<0.05) and were thus utilized to create the nomogram. The nomogram had well-fitted calibration curves and attained excellent concordance indices of 0.80 and 0.75. The sensitivity of nomogram in the diagnosis of SHCHI was 79.7%, the specificity was 68.1%. The area under the curve {AUC; 0.80 [95% confidence interval (CI): 0.74-0.86]} for diagnosing SHCHI by the nomogram was greater in comparison to that of APRI [0.78 (95% CI: 0.71-0.84)], and FIB-4 [0.76 (95% CI: 0.69-0.82)]. Patients with nomogram scores less than 119 were considered to have a lower risk of SHCHI. Conclusions: The constructed nomogram is suitable to serve as a SHCHI screening tool in chronic HBV-infected patients. But the dependability of the nomogram will necessitate further confirmation in a prospective study and further external validation is needed.

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A nomogram to predict survival in patients with acute-on-chronic hepatitis B liver failure after liver transplantation

Cited by 10 publications

References 32 publications

Factors Prognostic of Survival in Liver Transplant Recipients with Hepatitis B Virus Related Acute-on-Chronic Liver Failure

Factors Prognostic of Survival in Liver Transplant Recipients with Hepatitis B Virus Related Acute-on-Chronic Liver Failure

Prealbumin as a Predictor of Short-Term Prognosis in Patients with HBV-Related Acute-on-Chronic Liver Failure

Establishment and validation of a diagnostic nomogram for significant histopathologic changes of hepatic injury in HBV-infected patients

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