Li Wende, Liu Wanshu, Rong Yihui, Li Dongze, Zhu Bing, Yang Shaobo, Sun Shidong, You Shaoli, Chen Yu, Li Jun
Department of Infection and Liver Diseases, Peking University International Hospital, Beijing, China.
Department of Hepatology Medicine, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
J Clin Transl Hepatol. 2024 Oct 28;12(10):834-844. doi: 10.14218/JCTH.2024.00316. Epub 2024 Sep 30.
Early determination of prognosis in patients with acute-on-chronic liver failure (ACLF) is crucial for optimizing treatment options and liver allocation. This study aimed to identify risk factors associated with ACLF and to develop new prognostic models that accurately predict patient outcomes.
We retrospectively selected 1,952 hospitalized patients diagnosed with ACLF between January 2010 and June 2018. This cohort was used to develop new prognostic scores, which were subsequently validated in external groups.
The study included 1,386 ACLF patients and identified six independent predictors of 28-day mortality through multivariate analysis (all < 0.05). The new score, based on a multivariate regression model, demonstrated superior predictive accuracy for both 28-day and 90-day mortalities, with Areas under the ROC curves of 0.863 and 0.853, respectively (all < 0.05). This score can be used to stratify the risk of mortality among ACLF patients with ACLF, showing a significant difference in survival between patients categorized by the cut-off value (log-rank (Mantel-Cox) χ = 487.574 and 606.441, = 0.000). Additionally, the new model exhibited good robustness in two external cohorts.
This study presents a refined prognostic model, the Model for end-stage liver disease-complication score, which accurately predicts short-term mortality in ACLF patients. This model offers a new perspective and tool for improved clinical decision-making and short-term prognostic assessment in ACLF patients.
早期判定慢性肝病急性肝衰竭（ACLF）患者的预后对于优化治疗方案及肝脏分配至关重要。本研究旨在识别与ACLF相关的危险因素，并开发能准确预测患者预后的新预后模型。
我们回顾性选取了2010年1月至2018年6月期间确诊为ACLF的1952例住院患者。该队列用于开发新的预后评分，随后在外部群体中进行验证。
该研究纳入了1386例ACLF患者，通过多变量分析确定了28天死亡率的六个独立预测因素（均P<0.05）。基于多变量回归模型的新评分对28天和90天死亡率均显示出卓越的预测准确性，ROC曲线下面积分别为0.863和0.853（均P<0.05）。该评分可用于对ACLF患者的死亡风险进行分层，按临界值分类的患者之间生存率存在显著差异（对数秩（Mantel-Cox）χ² = 487.574和606.441，P = 0.000）。此外，新模型在两个外部队列中表现出良好的稳健性。
本研究提出了一种优化的预后模型，即终末期肝病-并发症评分模型，可准确预测ACLF患者的短期死亡率。该模型为改善ACLF患者的临床决策和短期预后评估提供了新的视角和工具。
