External validation and comparison of six prognostic models in a prospective cohort of HBV-ACLF in China
Related Experiment Video
Updated: Mar 26, 2026
A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Yi Shen1, Yan-Mei Liu1, Bin Wang2
1Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Jiangsu, China.
Insights
The integrated MELD score demonstrates superior accuracy in predicting both short-term and long-term outcomes for patients with hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF). This model offers a more robust prognostic tool compared to other prevalent scoring systems.
Area of Science:
- Hepatology
- Liver Disease Research
- Prognostic Modeling
Background:
- Acute-on-chronic liver failure (ACLF) presents a significant mortality challenge.
- Effective prognostic models for hepatitis B virus-associated ACLF (HBV-ACLF) are currently limited.
- Accurate prediction is crucial for timely intervention and management of HBV-ACLF.
Purpose of the Study:
- To evaluate and compare the predictive performance of six established scoring systems for HBV-ACLF.
- To assess short-term (3 months) and long-term (5 years) prognostic capabilities.
- To identify the optimal model for predicting outcomes in HBV-ACLF patients.
Main Methods:
- Prospective cohort study of 232 patients with HBV-ACLF.
- Validation of six models: MELD, MELD-Na, MESO, integrated MELD (iMELD), CTP, and mCTP.
- Evaluation of discrimination, calibration, and overall performance at 3 months and 5 years.
Main Results:
- All models, except CTP at 3 months, showed adequate calibration.
- The iMELD score exhibited the highest discrimination (AUC 0.76 at 3 months, AUC 0.80 at 5 years).
- iMELD demonstrated the best overall performance based on Nagelkerke's R2 and Brier score.
Conclusions:
- The integrated MELD (iMELD) score is a superior model for predicting prognosis in HBV-ACLF.
- iMELD offers improved accuracy for both short-term and long-term outcome prediction.
- This finding supports the use of iMELD for clinical decision-making in HBV-ACLF management.
Unlabelled:
Background. Acute-on-chronic liver failure has high mortality. Currently, robust models for predicting the outcome of hepatitis B virus (HBV)-associated ACLF are lacking.
Aim:
To assess and compare the performance of six prevalent models for short- and longterm prognosis in patients with HBV-ACLF.
Material And Methods:
The model for end-stage liver disease (MELD), MELD sodium (MELD-Na), MELD to sodium ratio (MESO), integrated MELD, Child-Turcotte-Pugh (CTP), and modified CTP (mCTP) were validated in a prospective cohort of 232 HBV-ACLF patients. The six models were evaluated by determining discrimination, calibration and overall performance at 3 months and 5 years.
Results:
According to the Hosmer-Lemeshow tests and calibration plots, all models could adequately describe the data except CTP at 3 months. Discrimination analysis showed that the iMELD score had the highest AUC of 0.76 with sensitivity of 62.6% and specificity of 80.2% for an optimal cut-off value of 52 at 3 months. It also had the highest AUC of 0.80 with sensitivity of 89.9% and specificity of 48.2% for an optimal cut-off value of 43 at 5 years. The overall performance of iMELD, assessed with Nagelkerke's R2 and the Brier score, was also the best among the six models.
Conclusion:
Integrated MELD may be the best model to predict short- and long-term prognosis in patients with HBV-ACLF.
