External validation and comparison of six prognostic models in a prospective cohort of HBV-ACLF in China

• Published in: Annals of hepatology 2016-03, Vol.15 (2), p.236-245
• Main Authors: Shen, Yi, Liu, Yan-Mei, Wang, Bin, Zhu, Yong-Gen, Wang, Yuan-Yuan, Wang, Xu-Lin, Ji, Ju-Ling, Shao, Jian-Guo, Qin, Yan, Qin, Gang
• Format: Article
• Language: English
• Subjects: Acute-on-chronic liver failure; Acute-On-Chronic Liver Failure - blood; Acute-On-Chronic Liver Failure - complications; Acute-On-Chronic Liver Failure - mortality; Adult; Age Factors; Aged; China; Cohort Studies; Discriminant Analysis; End Stage Liver Disease; Female; Gastroenterology and Hepatology; Hepatitis B virus; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - complications; Hepatitis B, Chronic - mortality; Humans; Male; Middle Aged; Prognosis; Prognostic scores; Prospective Studies; Severity of Illness Index; Sodium - blood; Young Adult
• ISSN: 1665-2681
• DOI: 10.5604/16652681.1193720

AbstractBackground. Acute-on-chronic liver failure has high mortality. Currently, robust models for predicting the outcome of hepatitis B virus (HBV)-associated ACLF are lacking. Aim. To assess and compare the performance of six prevalent models for short- and longterm prognosis in patients with HBV-ACLF. Material and methods. The model for end-stage liver disease (MELD), MELD sodium (MELD-Na), MELD to sodium ratio (MESO), integrated MELD, Child-Turcotte-Pugh (CTP), and modified CTP (mCTP) were validated in a prospective cohort of 232 HBV-ACLF patients. The six models were evaluated by determining discrimination, calibration and overall performance at 3 months and 5 years. Results. According to the Hosmer-Lemeshow tests and calibration plots, all models could adequately describe the data except CTP at 3 months. Discrimination analysis showed that the iMELD score had the highest AUC of 0.76 with sensitivity of 62.6% and specificity of 80.2% for an optimal cut-off value of 52 at 3 months. It also had the highest AUC of 0.80 with sensitivity of 89.9% and specificity of 48.2% for an optimal cut-off value of 43 at 5 years. The overall performance of iMELD, assessed with Nagelkerke’s R 2 and the Brier score, was also the best among the six models. Conclusion. Integrated MELD may be the best model to predict short- and long-term prognosis in patients with HBV-ACLF.