The scoring systems in predicting short-term outcomes in patients with hepatitis B virus-related acute-on-chronic liver failure

Abstract

Background: Hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) is a life-threatening syndrome characterized by acute and severe hepatic insults with high short-term mortality. This study aimed to compare the scoring systems which were used to predict short-term outcomes for HBV-ACLF patients. Methods: A total of 529 patients diagnosed as HBV-ACLF were retrospectively analyzed and randomly divided, at a ratio of 3:1, into derivation cohort (n=397) and validation cohort (n=132). Univariate and multivariate analyses were performed to determine the discriminative abilities of the ALBI grade in predicting 30-day and 90-day mortality. The area under the receiver operating characteristic (AUC) curves was used to evaluate the accuracy of models. Results: The survival was associated with lower ALBI score, MELD score and CLIF-C ACLF score than death. In the derivation cohort, elevated ALBI score was related to worse prognosis (30-day mortality: HR =3.452; 90-day mortality: HR =3.822), increased MELD score was associated with worse overall survival (30-day mortality: HR =1.073; 90-day mortality: HR =1.082), and increased CLIF-C ACLF score was associated with worse overall survival (30-day mortality: HR =1.061; 90-day mortality: HR =1.065). The multivariate analyses identified the ALBI score, MELD score and CLIF-C ACLF score as independent prognostic predictors. The results of validation cohort validated these findings. Conclusions: Our study revealed that both the ALBI score, MELD score and CLIF-C ACLF score could predict 30-and 90-day mortality of HBV-ACLF accurately. Elevated ALBI score, MELD score and CLIF-C ACLF score were associated with worse prognosis.