title: Prognostic performance of a series of model for end-stage liver disease and respective Δ scores in patients with hepatitis B acute-on-chronic liver failure.
abstract: The present study aimed to compare the short-term prognostic performance of a series of model for end-stage liver disease (MELD) and respective delta (∆) scores scoring systems in a population with acute-on-chronic hepatitis B liver failure (ACHBLF), and to investigate the potential effects from antivirals. A total of 77 patients with ACHBLF of mean age 46 years, 82% male, with 58.4% receiving antivirals, were recruited for this study. The ∆ scores for MELDs were defined as the changes one week after admission. Thirty‑eight (49%) patients (22 treated with antivirals) died within three months. The mean MELD and ∆MELD scores of the survival group were 19.5 ± 4.4 and 0.2 ± 3.7 respectively, and those of the mortality group were 23.5 ± 5.5 and 7.9 ± 6, respectively. The area under the receiver operating characteristic curve (AUC) for MELD, integrated MELD (iMELD), MELD with the addition of serum sodium (MELD-Na), updated MELD (upMELD), MELD excluding the international normalized ratio (INR; MELD-XI), United Kingdom MELD (UKMELD) and their ∆ scores were 0.72, 0.81, 0.77, 0.69, 0.65, 0.77 and 0.86, 0.83, 0.83, 0.82, 0.79 and 0.79, respectively. iMELD and MELD-Na significantly improved the accuracy of MELD (P<0.05). A cut-off value of 41.5 for the iMELD score can prognose 71% of mortalities with a specificity of 85%. In each pair of models, the ∆ score was superior to its counterpart, particularly when applied to patients with MELD ≤ 30. Decreased accuracy was observed for all models in the subset of patients treated with antivirals, although their baseline characteristics were comparable to those of untreated patients, while iMELD, MELD-Na and respective ∆ models remained superior with regard to the predictability. The iMELD and MELD-Na models predicted three-month mortality more accurately, while the ∆ models were superior to their counterparts when MELD ≤ 30; however, their performance was altered by antivirals, and thus requires optimization.
authors.affiliation: Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China.
authors.forename: Yun-Hao
authors.initials: YH
authors.lastname: Xun
authors.affiliation: Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China.
authors.forename: Jun-Ping
authors.initials: JP
authors.lastname: Shi
authors.affiliation: Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China.
authors.forename: Chun-Qing
authors.initials: CQ
authors.lastname: Li
authors.affiliation: Department of Infectious Diseases, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, P.R. China.
authors.forename: Dan
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China.
authors.forename: Wei-Zhen
authors.initials: WZ
authors.lastname: Shi
authors.affiliation: Department of Infectious Diseases, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, P.R. China.
authors.forename: Qing-Chun
authors.initials: QC
authors.lastname: Pan
authors.affiliation: Department of Liver Diseases, Hangzhou Sixth People's Hospital/Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang 310014, P.R. China.
authors.forename: Jian-Chun
authors.initials: JC
authors.lastname: Guo
authors.affiliation: Department of Infectious Diseases, Shanghai Sixth People's Hospital, Shanghai Jiaotong University, Shanghai 200233, P.R. China.
authors.forename: Guo-Qing
authors.initials: GQ
authors.lastname: Zang
mesh_terms: D000328:Adult; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality*; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index