Predicting the Onset of Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is a life-threatening syndrome with rapid progression. This study aimed to develop and validate a prognostic score to predict the onset of ACLF in hepatitis B virus (HBV) etiology.METHODS: The prospective clinical data of 1373 patients with acute deterioration of HBV-related chronic liver disease were used to identify clinical characteristics and develop a prognostic score for the onset of ACLF.RESULTS: Of the patients assessed using the Chinese Group on the Study of Severe Hepatitis B (COSSH)- ACLF criteria, 903 patients with non-ACLF at admission (1 received transplantation at 5 days) were stratified: 71 with progression to ACLF and 831 without progression to ACLF at 7 days. Four predictors (total bilirubin, international normalized ratio, alanine aminotransferase, and ferritin) were associated significantly with ACLF onset at 7 days. The COSSH-onset-ACLF score was constituted as follows: (0.101 x ln [alanine aminotransferase] + 0.819 x ln [total bilirubin] + 2.820 x ln [international normalized ratio] + 0.016 x ln [ferritin]). The C -in-dexes of the new score for 7-/14-/28-day onset (0.928/0.925/0.913) were significantly higher than those of 5 other scores (Chronic Liver Failure Consortium ACLF development score/ Model for End-stage Liver Disease score/Model for End-stage Liver Disease sodium score/ COSSH-ACLF score/Chronic liver failure Consortium ACLF score; all P < .001). The improve-ment in predictive errors, time-dependent receiver operating characteristic, probability den-sity function evaluation, and calibration curves of the new score showed the highest predictive value for ACLF onset at 7/14/28 days. Risk stratification of the new score showed 2 strata with high and low risk (double dagger 6.3/<6.3) of ACLF onset. The external validation group further confirmed the earlier results.CONCLUSIONS: A new prognostic score based on 4 predictors can accurately predict the 7-/14-/28-day onset of ACLF in patients with acute deterioration of HBV-related chronic liver disease and might be used to guide clinical management.