Related Experiment Video
Updated: Jun 12, 2026
Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
Published on: November 27, 2019
A Novel Simplified Prognostic Model for 90-day Transplant-free Survival in Patients with Severe Acute Liver
Yan Ren1,2, Manman Xu1,2, Wenling Wang1,2
1Fourth Department of Liver Disease, Beijing You'an Hospital, Capital Medical University, Beijing, China.
Background And Aims:
Early risk stratification of severe acute liver injury (SLI) that may progress to acute liver failure (ALF), is vital for timely intervention, but no universal prognostic assessment tool covers both conditions. This study aimed to develop a simplified prognostic model for early risk assessment in SLI/ALF patients.
Methods:
A retrospective cohort study consecutively enrolled SLI patients (including those progressing to ALF) from July 1, 2020 to May 31, 2025. Baseline clinical and laboratory data on admission were collected, with 90-day transplant-free survival as the primary outcome. Independent prognostic factors were screened via Cox regression to build a simplified scoring model, whose performance was compared with the Model for End-Stage Liver Disease (MELD), King's College Criteria (KCC), and the Acute Liver Failure Study Group Prognostic Index (ALFSG-PI).
Results:
Of 302 patients, 190 (62.9%) achieved 90-day transplant-free survival. Multivariate Cox regression identified international normalized ratio (hazard ratio [HR]: 1.118, 95% confidence interval [CI]: 1.050-1.191), platelet count (HR: 0.995, 95% CI: 0.993-0.998), and hepatic encephalopathy grade ≥ 2 (HR: 5.187, 95% CI: 3.403-7.907) as independent predictors, forming the HIP (derived from the above-mentioned three predictors) model. It showed good discrimination (area under the receiver operating characteristic curve [AUC]: 0.82), outperforming MELD (AUC: 0.76, P = 0.019) and KCC (AUC: 0.72, P = 0.002), and performing comparably to ALFSG-PI (AUC: 0.80, P = 0.429). The model also performed robustly in ALF subgroups defined by the American College of Gastroenterology and the 2024 Chinese Medical Association guidelines (AUCs: 0.80 and 0.76, respectively) and achieved an AUC of 0.85 in the validation set.
Conclusions:
The HIP model is a simple and effective tool for prognostic risk stratification in SLI/ALF patients, suitable for emergency and primary care to facilitate timely intervention.
