Development and validation of a novel prognostic score for HBV-related acute-on-chronic liver failure

Acute-on-chronic liver failure patients have high short-term mortality rates, and HBV infection is the most common cause. Current prognostic models for HBV-ACLF patients have limitations. Thus, the development of an ideal model remains an important unsolved problem.

To develop a new model and validate its prognostic predictive capacity.

Among 5854 liver failure patients admitted to the Second Affiliated Hospital of Chongqing Medical University from 2008 to 2023, 1170 HBV-ACLF cases were finally enrolled, which were randomly divided into a development cohort (n = 822) or validation cohort (n = 348). First, we obtained important predictive factors about 28-day and 90-day mortality using cox regression analysis and developed new prognostic scores. Second, the new scores were compared with current models through ROC curves, calibration curves and DCA curves. Third, using survival analysis, the new scores were risk-stratified according to optimal cut-off values.

The AHF-MELD and AHN-MELD scores' predictive capacity were stronger than MELD, MELD-sodium, CLIF-C OF and AARC scores and comparable to CLIF-C ACLF, COSSH ACLF and COSSH ACLF II scores. There was no significant difference between the observed and the predicted 28-day and 90-day mortality probabilities of new scores. The AHF-MELD and AHN-MELD scores have positive net benefits over a wide range of threshold probabilities and outperform conventional scores. The 28-day and 90-day survival rates were significantly lower in high-risk groups than in low-risk groups.

The AHF-MELD and AHN-MELD scores may serve as potential predictive tools for the short-term prognosis of HBV-ACLF patients. Our study may provide useful information for clinicians managing these patients.