Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure

Abstract

Group on the Study of Severe Hepatitis B (COSSH), Development and validation of a new prognostic score for hepatitis B virus-related acute-onchronic liver failure,

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

“…Similar to our findings, previous studies have reported that the CLIF-C ACLF scoring system was superior to the classical MELD and MELD-Na scores in evaluating the prognosis of patients with ACLF [ 14 , 25 ]. In contrast, other studies have suggested that the COSSH-ACLF scoring system was better than the CLIF-C ACLF system in evaluating the outcomes of patients with HBV-ACLF [ 1 , 2 ]. All of these studies, however, evaluated outcomes in ACLF patients who did not undergo LT. Based on these findings, the present study used the COSSH-ACLF scoring system to select and classify HBV-CALF recipients.…”

“…The present study found that the 1-year OS rate was significantly lower in patients with ACLF grade 3 than in those with ACLF grades 1 and 2. However, the 1-year OS rate in patients with ACLF grade 3 was 80% after LT, significantly higher than in patients with ACLF grade 3 who did not undergo LT [ 1 , 2 , 12 , 24 , 25 ]. These findings suggested that patients with HBV-ACLF be assessed for LT, with indications determined on an emergency basis, particularly for patients with a severe early course.…”

“…Hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) is a complex syndrome characterised by acute deterioration of liver function and high mortality rates, resulting in hepatic and extrahepatic organ failure due to chronic hepatitis B, regardless of the presence of cirrhosis [ 1 , 2 ]. Although some ACLF patients have autoimmune hepatitis, most patients with ACLF in the Asia-Pacific region have HBV-associated ACLF patients [ 3 – 6 ].…”

“…Several prognostic scoring systems have been formulated to evaluate LT-free survival of patients with HBV-ACLF, including the chronic liver failure-consortium ACLF (CLIF-C ACLF) score [ 14 ], the Chinese group on the study of severe hepatitis B-ACLF (COSSH-ACLF) score [ 2 ], the COSSH-ACLF II score [ 1 ], the model for end-stage liver disease (MELD) score [ 15 ], and the MELD-sodium (MELD-Na) score [ 16 ]. Although patients in China are usually evaluated by determining their COSSH-ACLF II scores [ 1 ], the optimum scoring system for evaluating outcomes of LT recipients who developed HBV-ACLF has not been determined. The present study therefore evaluated the risk factors for survival in HBV-ACLF patients following LT and determined the scoring system optimal for assessing patient prognosis.…”

Acute-on-Chronic Liver Failure in Cirrhosis

“…Recently, a simplified version of this score (COSSH-ACLF II) demonstrably improved prognostic accuracy and sensitivity for patients with HBV-ACLF. The COSSH-ACLF II score also allows easy division of patients into three different strata with significantly different 28-day mortality rates [27]. The COSSH-ACLF scores also include a subjective element in hepatic encephalopathy evaluation.…”