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Published on: November 27, 2019
CHINAT-CD4 Score Predicts Transplant-Free Survival in Patients with Acute-on-Chronic Liver Failure
Chenlu Huang1, Weixia Li2, Chong Chen2
1Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, People's Republic of China.
Insights
A new score incorporating CD4+ T cell count accurately predicts 28- and 90-day mortality in acute-on-chronic liver failure (ACLF) patients. This prognostic tool aids in early evaluation and management of ACLF, potentially reducing mortality rates.
Area of Science:
- Hepatology
- Immunology
- Prognostic Biomarkers
Background:
- Early prognosis evaluation is critical for reducing mortality in acute-on-chronic liver failure (ACLF).
- Existing prognostic scores may require enhancement for improved accuracy in diverse ACLF populations.
Purpose of the Study:
- To develop and validate a novel prognostic score for predicting mortality in patients with ACLF.
- To assess the predictive performance of the new score compared to existing models.
Main Methods:
- A prognostic score was developed using a derivation set of 408 patients with hepatitis B virus-related ACLF (HBV-ACLF).
- The score was validated in separate cohorts of HBV-ACLF (209 patients) and non-HBV-ACLF (195 patients).
- The score incorporates factors including creatinine, hepatic encephalopathy, international normalized ratio, neutrophils, aspartate aminotransferase, total bilirubin, and CD4+ T cell count.
Main Results:
- The novel score demonstrated strong predictive performance for 28-day and 90-day mortality, with C-indices of 0.810 and 0.806, respectively.
- Its predictive accuracy surpassed seven other established prognostic scores.
- Validation cohorts confirmed the score's efficacy, showing C-indices around 0.79-0.80 for both HBV-ACLF and non-HBV-ACLF groups.
Conclusions:
- The novel prognostic score, integrating CD4+ T cell count, accurately predicts short-term and mid-term mortality in ACLF patients.
- This score offers a valuable tool for clinical decision-making and patient management in ACLF.
Aim:
The early prognosis evaluation of acute-on-chronic liver failure (ACLF) is important to decrease its mortality. We aimed to develop a new score to accurately predict the outcome of patients with ACLF.
Methods:
A derivation set of 408 patients with hepatitis B virus-related ACLF (HBV-ACLF) based on the Asian Pacific Association for the Study of the Liver criteria is used to develop a prognostic score that was validated in 209 patients with HBV-ACLF and 195 patients with non-HBV-ACLF.
Results:
Seven factors were significantly related to the 28-day mortality and constituted a new score (CHINAT-CD4 = 0.320 × ln (creatinine) + 0.668 × hepatic encephalopathy score + 0.745 × ln (international normalized ratio) + 0.476 × ln (neutrophil) + 0.251 × ln (aspartate aminotransferase) + 0.411 × ln (total bilirubin) - 0.605 × ln (CD4+ T cells count)). The C-indices of the new score for the 28-/90-day mortality (0.810/0.806) outperformed those of the other seven scores (p≤0.05). The results were confirmed in a validation set (0.798/793 for HBV-ACLF; 0.790/0.788 for non-HBV-ACLF). The novel score based on CD4+ T cell count showed high predictive performance for the 28-/90-day mortality of ACLF.
Conclusion:
The novel score based on CD4+ T cell count can accurately predict the 28-/90-day mortality for patients with ACLF.
