title: External validation and comparison of six prognostic models in a prospective cohort of HBV-ACLF in China.
abstract: Background. Acute-on-chronic liver failure has high mortality. Currently, robust models for predicting the outcome of hepatitis B virus (HBV)-associated ACLF are lacking.
  
  
  OBJECTIVE
  To assess and compare the performance of six prevalent models for short- and longterm prognosis in patients with HBV-ACLF.
  
  
  METHODS
  The model for end-stage liver disease (MELD), MELD sodium (MELD-Na), MELD to sodium ratio (MESO), integrated MELD, Child-Turcotte-Pugh (CTP), and modified CTP (mCTP) were validated in a prospective cohort of 232 HBV-ACLF patients. The six models were evaluated by determining discrimination, calibration and overall performance at 3 months and 5 years.
  
  
  RESULTS
  According to the Hosmer-Lemeshow tests and calibration plots, all models could adequately describe the data except CTP at 3 months. Discrimination analysis showed that the iMELD score had the highest AUC of 0.76 with sensitivity of 62.6% and specificity of 80.2% for an optimal cut-off value of 52 at 3 months. It also had the highest AUC of 0.80 with sensitivity of 89.9% and specificity of 48.2% for an optimal cut-off value of 43 at 5 years. The overall performance of iMELD, assessed with Nagelkerke's R2 and the Brier score, was also the best among the six models.
  
  
  CONCLUSIONS
  Integrated MELD may be the best model to predict short- and long-term prognosis in patients with HBV-ACLF.
authors: Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Jiangsu, China.
authors: Yi
authors: Y
authors: Shen
authors: Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Jiangsu, China.
authors: Yan-Mei
authors: YM
authors: Liu
authors: ** Center for Liver Diseases, Nantong Third People's Hospital, Nantong University, Jiangsu, China.
authors: Bin
authors: B
authors: Wang
authors: ** Center for Liver Diseases, Nantong Third People's Hospital, Nantong University, Jiangsu, China.
authors: Yong-Gen
authors: YG
authors: Zhu
authors: Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Jiangsu, China.
authors: Yuan-Yuan
authors: YY
authors: Wang
authors: Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Jiangsu, China.
authors: Xu-Lin
authors: XL
authors: Wang
authors: Department of Pathology, Medical School, Nantong University, Jiangsu, China.
authors: Ju-Ling
authors: JL
authors: Ji
authors: Center for Liver Diseases, Nantong Third People's Hospital, Nantong University, Jiangsu, China.
authors: Jian-Guo
authors: JG
authors: Shao
authors: Department of Internal Medicine, Singapore General Hospital, Singapore.
authors: Yan
authors: Y
authors: Qin
authors: Center for Liver Diseases, Nantong Third People's Hospital, Nantong University, Jiangsu, China.
authors: Gang
authors: G
authors: Qin
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000097:blood / Q000150:complications / Q000401:mortality*; D000328:Adult; D000367:Age Factors; D000368:Aged; D002681:China; D015331:Cohort Studies; D016002:Discriminant Analysis; D058625:End Stage Liver Disease; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood; D055815:Young Adult
chemical_list: D012964:Sodium