Establishment and Validation of ALPH-Q Score to Predict Mortality Risk in Patients With Acute-on-Chronic Hepatitis B Liver Failure

Abstract

Currently, there are no robust models for predicting the outcome of acute-on-chronic hepatitis B liver failure (ACHBLF). We aimed to establish and validate a new prognostic scoring system, named ALPH-Q, that integrates electrocardiography parameters that may be used to predict short-term mortality of patients with ACHBLF.Two hundred fourteen patients were included in this study. The APLH-Q score was constructed by Cox proportional hazard regression analysis and was validated in an independent patient cohort. The area under the receiver-operating characteristic curve was used to compare the performance of different models, including APLH-Q, Child–Pugh score (CPS), model of end-stage liver disease (MELD), and a previously reported logistic regression model (LRM).The APLH-Q score was constructed with 5 independent risk factors, including age (HR = 1.034, 95% CI: 1.007–1.061), liver cirrhosis (HR = 2.753, 95% CI: 1.366–5.548), prothrombin time (HR = 1.031, 95% CI: 1.002–1.062), hepatic encephalopathy (HR = 2.703, 95% CI: 1.630–4.480), and QTc (HR = 1.008, 95% CI: 1.001–1.016). The performance of the ALPH-Q score was significantly better than that of MELD and CPS in both the training (0.896 vs 0.712, 0.896 vs 0.738, respectively, both P < 0.05) and validation cohorts (0.837 vs 0.689, 0.837 vs 0.585, respectively, both P < 0.05). Compared with LRM, APLH-Q also showed a better performance (0.896 vs 0.825, 0.837 vs 0.818, respectively).We have developed a novel APLH-Q score with greater performance than CPS, MELD, and LRM for predicting short-term mortality of patients with ACHBLF.

Performance of scoring systems to predict mortality of patients with acute‐on‐chronic liver failure: A systematic review and meta‐analysis

“…) . MELD score was the most commonly used scoring system, which was used in 24 studies (28 cohorts) involving 4663 patients . Followed by CPT score, which was used in 12 studies (16 cohorts) involving 2226 patients .…”

“…MELD score was the most commonly used scoring system, which was used in 24 studies (28 cohorts) involving 4663 patients . Followed by CPT score, which was used in 12 studies (16 cohorts) involving 2226 patients . Moreover, eight studies (nine cohorts) involving 1500 patients were included in the analysis of MELD‐Na score .…”

“…18,[20][21][22][23][24][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Followed by CPT score, which was used in 12 studies (16 cohorts) involving 2226 patients. 20,24,27,31,[33][34][35]37,[39][40][41]43 Moreover, eight studies (nine cohorts) involving 1500 patients were included in the analysis of MELD-Na score. 22,26,[33][34][35]38,40,41 Five cohorts from four studies with 617 patients reported data for analysis of SOFA score.…”

Bone Mineral Density Assessment in Chronic Liver Disease

“…Severity assessment of the liver disease in patients with cirrhosis was done by Child Pugh Score (CTP) [24] and Model for end-stage liver disease (MELD) [25] scores.…”

Letter: aberrant GSTP1 promoter methylation in acute‐on‐chronic hepatitis B liver failure

“…Acuteon-chronic hepatitis B liver failure (ACHBLF) is a lifethreatening disease, with a mortality of 33-50%. 2,3 Liver transplantation is the only option for those who failed to respond to supportive therapy. Early identification of patients with poor prognosis is helpful for the efficient organ allocation and reduction in mortality.…”