Nomogram prediction of individual prognosis of patients with acute-on-chronic hepatitis B liver failure

Gao, Fangyuan; Zhang, Qianqian; Liu, Yao; Gong, Guozhong; Mao, Dewen; Gong, Zhengliang; Li, Jun; Luo, Xinla; Li, Xiaoliang; Chen, Guoliang; Li, Yong; Zhao, Wenxia; Wu, Gang; Li, Hai; Sun, Kewei; Wang, Xianbo

doi:10.1016/j.dld.2018.08.023

Cited by 17 publications

(15 citation statements)

References 35 publications

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“…We previously demonstrated that the neutrophil-to-lymphocyte ratio (NLR) predicts disease progression and mortality in HBV-ACLF patients, consistent with other studies ( 14 , 15 ). In this study, the phenotypic, transcriptomic, and functional alterations were characterized in circulating neutrophils from HBV-ACLF patients.…”

Section: Introductionsupporting

confidence: 90%

Circulating Neutrophil Dysfunction in HBV-Related Acute-on-Chronic Liver Failure

Wu¹,

Sun²,

Wang³

et al. 2021

Front. Immunol.

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Background and AimsAcute-on-chronic liver failure (ACLF) is characterized by systemic inflammation accompanied by defective anti-bacterial immunity. The role of neutrophils in immune derangement of ACLF has not been fully elucidated. This study is aimed to characterize the role of circulating neutrophils in HBV-related ACLF patients.MethodsQuantitative, phenotypic, transcriptomic, and functional alterations of circulating neutrophils were compared in ACLF and non-ACLF subjects and analyzed for associations with short-term outcomes. Interventional experiments were performed to test the impact on ACLF-patient neutrophil function in vitro.ResultsCirculating absolute neutrophil count was significantly increased in patients with ACLF and was an independent risk factor for 28-day mortality. ACLF-patient neutrophils differentially expressed a panel of surface markers (include TLR-1, TLR-2, TLR-4, CEACAM-1 and FPR1), as well as a distinct transcriptomic signature. ACLF-neutrophils displayed significantly impaired phagocytosis but an increased capacity to form neutrophil extracellular traps (NETs), which was more pronounced in patients with poor outcome. Healthy neutrophils mimicked functional characteristics of ACLF counterpart after co-cultured with plasma from ACLF patients. The oxidative burst and cytokine production capacities remained unchanged. Plasma GM-CSF, IL-6, IL-8, IL-10, and IP-10 levels, as well as lipopolysaccharide (LPS) concentration, were markedly elevated in ACLF patients but not DAMP molecules HMGB-1 and HSP70. Finally, a glycolysis inhibitor, 2-deoxy-glucose, reduced NET formation of ACLF patients’ neutrophils.ConclusionsCirculating ACLF-patient neutrophils exhibit alterations in number, phenotype, gene expression and function, which was associated with poor outcome and shaped by the ACLF circulatory environment. Inhibiting glycolysis can reverse neutrophil dysfunction in ACLF patients.

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Section: Introductionsupporting

confidence: 90%

Circulating Neutrophil Dysfunction in HBV-Related Acute-on-Chronic Liver Failure

Wu¹,

Sun²,

Wang³

et al. 2021

Front. Immunol.

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“…Our analyses did not identify MELD score as an independent predictor of death; however, the association of COSSH‐ACLF score with mortality was identified in univariate and multivariate analysis. This result is consistent with previous studies, which have reported COSSH‐ACLF score to be superior or comparable with other scores for the evaluation of severity and prediction of poor outcomes of HBV‐ACLF 5,20 . We believe this is partly because the COSSH‐ACLF score considers organ failures (such as cerebral or respiratory function failure), which MELD score does not include.…”

Section: Discussionsupporting

confidence: 91%

“…This result is consistent with previous studies, which have reported COSSH-ACLF score to be superior or comparable with other scores for the evaluation of severity and prediction of poor outcomes of HBV-ACLF. 5,20 We believe this is partly because the COSSH-ACLF score considers organ failures (such as cerebral or respiratory function failure), which MELD score does not include. Previous studies have identified several factors including mean platelet volume, 21 plasma fibrinogen level, 22 serum homocysteine, 23 and serum ferritin 24 to be associated with poor outcomes of HBV-ACLF.…”

Section: Discussionmentioning

confidence: 99%

Ammonia predicts poor outcomes in patients with hepatitis B virus‐related acute‐on‐chronic liver failure

Zhang

Liu

et al. 2020

Clinical Laboratory Analysis

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Acute-on-chronic liver failure (ACLF) is the rapid deterioration of liver function in chronic liver disease often associated with the development of serious complications such as hepatorenal syndrome and hepatic encephalopathy (HE) within a short period of time. 1,2 The condition has a high rate of short-term mortality, with previous studies reporting that around 50%-90% ACLF patients will die within 1 month of diagnosis. 3,4 While the definition and etiology of ACLF differ between Eastern and Western countries, the condition is generally described as acute deterioration of pre-existing chronic liver disease, and guidelines identify patients with cirrhosis at a high risk of short-term mortality in cases that develop ACLF. Alcoholic liver disease is the most common etiology of ACLF in patients from Europe and North America; however, hepatitis B virus (HBV) infection represents the major etiology among patients from the Asia-Pacific region. Based on the results of the European Association for the Study of the Liver definition of ACLF, the Chinese Group on the Study of Severe Hepatitis B (COSSH) recently developed new criteria for HBV-ACLF and established a prognostic score based on characteristics of Chinese patients with HBV and chronic liver disease. 5 Regardless of the presence of cirrhosis, patients with chronic hepatitis B with total bilirubin (TBIL) of ≥205 μmol/L and international normalized ratio (INR) of ≥1.5 are defined as HBV-ACLF according to the new criteria for HBV-ACLF. These criteria bridge the

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“…Therefore, there is an urgent need for patients with AMI to more precise risk stratification methods, individual treatment and follow-up strategies. The nomogram is a visual medical prediction model that can provide accurate and personalized predictions for patient OS, and allows clinicians to make standardized clinical decisions [21].…”

Section: Discussionmentioning

confidence: 99%

Development and validation of nomogram to predict long-term prognosis of critically ill patients with acute myocardial infarction

Tang

Zha

Zeng

et al. 2020

Preprint

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Background: Acute myocardial infarction (AMI) is a common critical illness in the cardiovascular field, with poor prognosis. This study aimed to construct a nomogram to predict long-term survival of critically ill patients with AMI, which helps to assess severity, guide treatment, and improve prognosis. Methods and results: The clinical data of patients with AMI was extracted from the database MIMIC-III v1.4. The Cox proportional hazards models were performed to identify the independently prognostic factors, and a nomogram for predicting long-term survival of AMI patients was developed based on the multifactor analysis, of which discriminative ability and accuracy was evaluated by concordance index (C-index) and calibration curve. Results: A total of 1202 patients were included in the analysis, of which 841 were divided into the training set and 361 were the validation. Multivariate analysis shown that age, blood urea nitrogen, respiratory rate, SAPSII score, cardiogenic shock, cardiac arrhythmias, and respiratory failure served as the independently predictive factors, which were incorporated into the nomogram. Moreover, the nomogram shown favorable performance for predicting 4-year survival of AMI patients with the C- index of 0.788 [95% confidence interval (CI): 0.763 to 0.813] and 0.783 (95% CI: 0.748 to 0.818) in the training and validation set, respectively. Conclusion: The nomogram we constructed here can accurately predict the long-term survival of patients with AMI.

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Nomogram prediction of individual prognosis of patients with acute-on-chronic hepatitis B liver failure

Abstract: The proposed nomogram could accurately estimate individualized risk for the short-term mortality of patients with ACHBLF as defined by APASL.

Cited by 17 publications

References 35 publications

Circulating Neutrophil Dysfunction in HBV-Related Acute-on-Chronic Liver Failure

Circulating Neutrophil Dysfunction in HBV-Related Acute-on-Chronic Liver Failure

Ammonia predicts poor outcomes in patients with hepatitis B virus‐related acute‐on‐chronic liver failure

Development and validation of nomogram to predict long-term prognosis of critically ill patients with acute myocardial infarction

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