[A simple scoring system to evaluate the severity of acute-on-chronic liver failure in hepatitis B]

To establish an objective, simple and sensitive scoring system to evaluate the severity of acute-on-chronic liver failure in hepatitis B.

The clinical data of patients (194 survivals and 215 deaths) with acute-on-chronic liver failure in hepatitis B were collected and analyzed prospectively. 7 clinical indexes, including the hepatic encephalopathy, creatinine, prothrombin activity, serum total bilirubin, infection, the dimension of liver, the maximum depth of ascites, were scored objectively and simply from 0 to 4 points according to their severity. Then we calculated every patient's total score and divided the 409 patients into two groups: the one was 309 patients and the other is 100 patients. The first group was to establish the severity scoring system and define the cut-off-point, the second group was to test the severity scoring system.

The total score of the 144 patients in the survival group was 6.9 +/- 3.2, 165 patients in the dead group was 15.8 +/- 4.0, respectively. There were significant differences (P < 0.01) between the two groups. The area under ROC curve was 0.953. The cut-off-point is 9.5. The sensitivity was 0.97, the specificity was 0.82. The second group patients' total score were divided into two groups: the one is > or = 10 score and the other is < or = 9 score. The prognosis of the first group was much worse than the second group, it's mortality rate was 87.5%; the second was 2.3%. There were significant differences between the two groups (P < 0.01).

This scoring system was simple, sensitive and objective to evaluate the severity of acute-on-chronic liver failure in hepatitis B.