title: Comparison of four prognostic models and a new Logistic regression model to predict short-term prognosis of acute-on-chronic hepatitis B liver failure.
abstract: BACKGROUND
  Acute-on-chronic hepatitis B liver failure (ACLF-HBV) is a clinically severe disease associated with major life-threatening complications including hepatic encephalopathy and hepatorenal syndrome. The aim of this study was to evaluate the short-term prognostic predictability of the model for end-stage liver disease (MELD), MELD-based indices, and their dynamic changes in patients with ACLF-HBV, and to establish a new model for predicting the prognosis of ACLF-HBV.
  
  
  METHODS
  A total of 172 patients with ACLF-HBV who stayed in the hospital for more than 2 weeks were retrospectively recruited. The predictive accuracy of MELD, MELD-based indices, and their dynamic change (D) were compared using the area under the receiver operating characteristic curve method. The associations between mortality and patient characteristics were studied by univariate and multivariate analyses.
  
  
  RESULTS
  The 3-month mortality was 43.6%. The largest concordance (c) statistic predicting 3-month mortality was the MELD score at the end of 2 weeks of admission (0.8), followed by the MELD: sodium ratio (MESO) (0.796) and integrated MELD (iMELD) (0.758) scores, DMELD (0.752), DMESO (0.729), and MELD plus sodium (MELD-Na) (0.728) scores. In multivariate Logistic regression analysis, the independent factors predicting prognosis were hepatic encephalopathy (OR = 3.466), serum creatinine, international normalized ratio (INR), and total bilirubin at the end of 2 weeks of admission (OR = 10.302, 6.063, 5.208, respectively), and cholinesterase on admission (OR = 0.255). This regression model had a greater prognostic value (c = 0.85, 95%CI 0.791 - 0.909) compared to the MELD score at the end of 2 weeks of admission (Z = 4.9851, P = 0.0256).
  
  
  CONCLUSIONS
  MELD score at the end of 2 weeks of admission is a useful predictor for 3-month mortality in ACLF-HBV patients. Hepatic encephalopathy, serum creatinine, international normalized ratio, and total bilirubin at the end of 2 weeks of admission and cholinesterase on admission are independent predictors of 3-month mortality.
authors.affiliation: Liver Failure Therapy and Research Centre, 302 Hospital of People's Liberation Army, Beijing 100039, China.
authors.forename: Wei-Ping
authors.initials: WP
authors.lastname: He
authors.forename: Jin-Hua
authors.initials: JH
authors.lastname: Hu
authors.forename: Jun
authors.initials: J
authors.lastname: Zhao
authors.forename: Jing-Jing
authors.initials: JJ
authors.lastname: Tong
authors.forename: Jin-Biao
authors.initials: JB
authors.lastname: Ding
authors.forename: Fang
authors.initials: F
authors.lastname: Lin
authors.forename: Hui-Fen
authors.initials: HF
authors.lastname: Wang
mesh_terms: D000328:Adult; D005260:Female; D019694:Hepatitis B, Chronic / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D017093:Liver Failure / Q000473:pathology* / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical