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- Title
Prediction of the prognosis of patients with acute-on-chronic hepatitis B liver failure using the model for end-stage liver disease scoring system and a novel logistic regression model.
- Authors
Sun, Q.-F.; Ding, J.-G.; Xu, D.-Z.; Chen, Y.-P.; Hong, L.; Ye, Z.-Y.; Zheng, M.-H.; Fu, R.-Q.; Wu, J.-G.; Du, Q.-W.; Chen, W.; Wang, X.-F.; Sheng, J.-F.
- Abstract
The objective of this study was to determine the predictive value of the model for end-stage liver disease (MELD) scoring system in patients with acute-on-chronic hepatitis B liver failure (ACLF-HBV), and to establish a new model for predicting the prognosis of ACLF-HBV. A total of 204 adult patients with ACLF-HBV were retrospectively recruited between July 1, 2002 and December 31, 2004. The MELD scores were calculated according to the widely accepted formula. The 3-month mortality was calculated. The validity of the MELD model was determined by means of the concordance ( c) statistic. Clinical data and biochemical values were included in the multivariate logistic regression analysis based on which the regression model for predicting prognosis was established. The receiver-operating characteristic curves were drawn for the MELD scoring system and the new regression model and the areas under the curves (AUC) were compared by the z-test. The 3-month mortality rate was 57.8%. The mean MELD score for the patients who died was significantly greater than those who survived beyond 3 months (28.7 vs 22.4, P = 0.003). The concordance ( c) statistic (equivalent to the AUC) for the MELD scoring system predicting 3-month mortality was 0.709 (SE = 0.036, P < 0.001, 95% confidence interval 0.638–0.780). The independent factors predicting prognosis were hepatorenal syndrome ( P < 0.001), liver cirrhosis ( P = 0.009), HBeAg ( P = 0.013), albumin ( P = 0.028) and prothrombin activity ( P = 0.011) as identified in multivariate logistic regression analysis. The regression model that was constructed by the logistic regression analysis produced a greater prognostic value ( c = 0.891) than the MELD scoring system ( z = 4.333, P < 0.001). The MELD scoring system is a promising and useful predictor for 3-month mortality of ACLF-HBV patients. Hepatorenal syndrome, liver cirrhosis, HBeAg, albumin and prothrombin activity are independent factors affecting the 3-month mortality. The newly established logistic regression model appears to be superior to the MELD scoring system in predicting 3-month mortality in patients with ACLF-HBV.
- Subjects
LIVER failure; LIVER diseases; GLYCOPROTEINS; HEPATITIS B; PATIENTS; THERAPEUTICS
- Publication
Journal of Viral Hepatitis, 2009, Vol 16, Issue 7, p464
- ISSN
1352-0504
- Publication type
Article
- DOI
10.1111/j.1365-2893.2008.01046.x