Yu Zhenjun, Zhang Yu, Li Yuhan, Zhou Feng, Xu Manman, You Shaoli, Chen Yu, Zhu Bing, Kong Ming, Song Fangjiao, Xin Shaojie, Duan Zhongping, Han Tao
Department of Hepatology and Gastroenterology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China.
Liver Disease Center (Difficult and Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital Affiliated to Capital Medical University, Beijing, China.
J Clin Transl Hepatol. 2022 Oct 28;10(5):867-878. doi: 10.14218/JCTH.2021.00328. Epub 2022 Jan 18.
Acute-on-chronic liver failure (ACLF) tends to progress rapidly with high short-term mortality. We aimed to create a widely applicable, simple prognostic (WASP) score for ACLF patients.
A retrospective cohort of ACLF cases recruited from three centers in China were divided into training and validation sets to develop the new score. A prospective longitudinal cohort was recruited for further validation.
A total of 541 cases were included in the training set, and seven independent ACLF prognostic factors were screened to construct a new quantitative WASP-ACLF table. In the validation set of 671 cases, WASP-ACLF showed better predictive ability for 28-day and 90-day mortality than the currently used prognostic scores at baseline, day 3, week 1, and week 2. The predictive efficacy and clinical validity of the model improved over time. Patients were assigned to low-, intermediate-, and high-risk groups by their WASP-ACLF scores. Compared with the other two groups, intermediate-risk patients had a more uncertain prognosis, with a 90-day mortality of 44.4-50.6%. Sequential assessments at weeks 1 and 2 found the 90-day mortality of intermediate-risk groups was <20% for patients with a ≥2 point decrease in WASP-ACLF and was up to 56% for patients with a ≥2 points increase. Similar results were observed in prospective data.
The new ACLF prognostic score was simple, widely applicable, and had good predictive efficacy. Continuous assessments and trend of change in WASP-ACLF need to be considered, especially for intermediate-risk patients.
慢加急性肝衰竭（ACLF）往往进展迅速，短期死亡率高。我们旨在为ACLF患者创建一个广泛适用的简单预后（WASP）评分。
从中国三个中心招募的ACLF病例回顾性队列被分为训练集和验证集以开发新评分。招募了一个前瞻性纵向队列进行进一步验证。
训练集共纳入541例病例，筛选出7个独立的ACLF预后因素以构建新的定量WASP-ACLF表。在671例病例的验证集中，WASP-ACLF在基线、第3天、第1周和第2周对28天和90天死亡率的预测能力优于目前使用的预后评分。该模型的预测效能和临床有效性随时间提高。根据WASP-ACLF评分将患者分为低、中、高风险组。与其他两组相比，中风险患者的预后更不确定，90天死亡率为44.4%-50.6%。在第1周和第2周的连续评估发现，WASP-ACLF下降≥2分的中风险组患者90天死亡率<20%，而WASP-ACLF增加≥2分的患者90天死亡率高达56%。前瞻性数据中观察到类似结果。
新的ACLF预后评分简单、广泛适用且具有良好的预测效能。需要考虑WASP-ACLF的连续评估和变化趋势，尤其是对于中风险患者。
