title: Development of a sensitive prognostic scoring system for the evaluation of severity of acute-on-chronic hepatitis B liver failure: a retrospective cohort study.
abstract: OBJECTIVE
  The purpose of the current study was to establish an objective, simple, and sensitive prognostic scoring system for estimating the severity of acute-on-chronic liver failure in hepatitis B (ACLFB).
  
  
  METHODS
  A novel prognostic scoring system was calculated from six clinical indices including total bilirubin (TB), prothrombin activity (PTA), creatinine (Cr), hepatic encephalopathy (HE), infections, and the depth of ascites from 726 patients with ACLFB. Indices were scored from 1 to 4 according to their severity. Groups of the same patients were scored with three-indices (TB, PTA and Cr), four-indices (TB, PTA, Cr and HE), five-indices (TB, PTA, Cr, HE and the depth of ascites) or six-indices (TB, PTA, Cr, HE, the depth of ascites, and infections). The differences in the sensitivity and specificity of four scoring systems were analyzed.
  
  
  RESULTS
  The demarcation points of the three-, four-, five- and six-indices scoring systems were 4.62, 6.12, 7.88 and 9.57, respectively. The analysis of the areas under the receiver operating characteristic (ROC) curve indicated that the four-, five- and six-indices scoring systems were more exact, and objective than the three-indices prognostic scoring system. In the six-indices scoring system, the survival rates of patients with scores from 2 to 6 was 98.31% (233/237), and the mortality rate of patients with scores of 16 and above was 100.00% (140/140), while the mortality rates were 8.33% (3/36) and 96.43% (27/28) for those with scores from 7 to 15, respectively.
  
  
  CONCLUSIONS
  A six-indices scoring system is an objective, pertinent, and sensitive system, and may be useful for the prognostic evaluation of ACLFB.
authors.affiliation: Department of Infectious Diseases, The Third Affilliated Hospital, Sun Yat-sen University, Guangzhou City, 510630 PR China.
authors.forename: Yu-Bao
authors.initials: YB
authors.lastname: Zheng
authors.forename: Dong-Ying
authors.initials: DY
authors.lastname: Xie
authors.forename: Yu-Rong
authors.initials: YR
authors.lastname: Gu
authors.forename: Ying
authors.initials: Y
authors.lastname: Yan
authors.forename: Ye-Bin
authors.initials: YB
authors.lastname: Wu
authors.forename: Zi-Ying
authors.initials: ZY
authors.lastname: Lei
authors.forename: Liang
authors.initials: L
authors.lastname: Peng
authors.forename: Shi-Bin
authors.initials: SB
authors.lastname: Xie
authors.forename: Zhi-liang
authors.initials: ZL
authors.lastname: Gao
authors.forename: Wei-min
authors.initials: WM
authors.lastname: Ke
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies