title: Establishment and validation of ALPH-Q score to predict mortality risk in patients with acute-on-chronic hepatitis B liver failure: a prospective cohort study.
abstract: Currently, there are no robust models for predicting the outcome of acute-on-chronic hepatitis B liver failure (ACHBLF). We aimed to establish and validate a new prognostic scoring system, named ALPH-Q, that integrates electrocardiography parameters that may be used to predict short-term mortality of patients with ACHBLF. Two hundred fourteen patients were included in this study. The APLH-Q score was constructed by Cox proportional hazard regression analysis and was validated in an independent patient cohort. The area under the receiver-operating characteristic curve was used to compare the performance of different models, including APLH-Q, Child-Pugh score (CPS), model of end-stage liver disease (MELD), and a previously reported logistic regression model (LRM). The APLH-Q score was constructed with 5 independent risk factors, including age (HR = 1.034, 95% CI: 1.007-1.061), liver cirrhosis (HR = 2.753, 95% CI: 1.366-5.548), prothrombin time (HR = 1.031, 95% CI: 1.002-1.062), hepatic encephalopathy (HR = 2.703, 95% CI: 1.630-4.480), and QTc (HR = 1.008, 95% CI: 1.001-1.016). The performance of the ALPH-Q score was significantly better than that of MELD and CPS in both the training (0.896 vs 0.712, 0.896 vs 0.738, respectively, both P < 0.05) and validation cohorts (0.837 vs 0.689, 0.837 vs 0.585, respectively, both P < 0.05). Compared with LRM, APLH-Q also showed a better performance (0.896 vs 0.825, 0.837 vs 0.818, respectively).We have developed a novel APLH-Q score with greater performance than CPS, MELD, and LRM for predicting short-term mortality of patients with ACHBLF.
authors.affiliation: From the Department of Cardiovascular Medicine (S-JW, Z-XZ, B-ZY, W-JH), the Heart Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou; Department of Infectious Diseases (H-DY), Ningbo No. 2 Hospital, Ningbo; Department of Infection and Liver Diseases (K-QS, F-LW, Y-PC, M-HZ), Liver Research Center (K-QS, F-LW, Y-PC, M-HZ), the First Affiliated Hospital of Wenzhou Medical University; Institute of Hepatology, Wenzhou Medical University; Department of Clinical Laboratory (Y-YX), the First Affiliated Hospital of Wenzhou Medical University, Wenzhou; Department of Hepatology (Y-CF), Qilu Hospital of Shandong University, Jinan, China.
authors.forename: Sheng-Jie
authors.initials: SJ
authors.lastname: Wu
authors.forename: Hua-Dong
authors.initials: HD
authors.lastname: Yan
authors.forename: Zai-Xing
authors.initials: ZX
authors.lastname: Zheng
authors.forename: Ke-Qing
authors.initials: KQ
authors.lastname: Shi
authors.forename: Fa-Ling
authors.initials: FL
authors.lastname: Wu
authors.forename: Yao-Yao
authors.initials: YY
authors.lastname: Xie
authors.forename: Yu-Chen
authors.initials: YC
authors.lastname: Fan
authors.forename: Bo-Zhi
authors.initials: BZ
authors.lastname: Ye
authors.forename: Wei-Jian
authors.initials: WJ
authors.lastname: Huang
authors.forename: Yong-Ping
authors.initials: YP
authors.lastname: Chen
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Zheng
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D000328:Adult; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index