Logistic regression model can reduce unnecessary artificial liver support in hepatitis B virus-associated acute-on-chronic liver failure: decision curve analysis.
Several models have been proposed to predict the short-term outcome of acute-on-chronic liver failure (ACLF) after treatment. We aimed to determine whether better decisions for artificial liver support system (ALSS) treatment could be made with a model than without, through decision curve analysis (DCA).



The medical profiles of a cohort of 232 patients with hepatitis B virus (HBV)-associated ACLF were retrospectively analyzed to explore the role of plasma prothrombin activity (PTA), model for end-stage liver disease (MELD) and logistic regression model (LRM) in identifying patients who could benefit from ALSS. The accuracy and reliability of PTA, MELD and LRM were evaluated with previously reported cutoffs. DCA was performed to evaluate the clinical role of these models in predicting the treatment outcome.



With the cut-off value of 0.2, LRM had sensitivity of 92.6 %, specificity of 42.3 % and an area under the receiving operating characteristic curve (AUC) of 0.68, which showed superior discrimination over PTA and MELD. DCA revealed that the LRM-guided ALSS treatment was superior over other strategies including "treating all" and MELD-guided therapy, for the midrange threshold probabilities of 16 to 64 %.



The use of LRM-guided ALSS treatment could increase both the accuracy and efficiency of this procedure, allowing the avoidance of unnecessary ALSS.
Center for Liver Diseases, Nantong Third People's Hospital, Nantong University, Jiangsu, China. tonygqin@ntu.edu.cn.|Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Jiangsu, China. tonygqin@ntu.edu.cn.
Gang
G
Qin
Center for Liver Diseases, Nantong Third People's Hospital, Nantong University, Jiangsu, China.
Zhao-Lian
ZL
Bian
Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Jiangsu, China.
Yi
Y
Shen
Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia.
Lei
L
Zhang
Center for Liver Diseases, Nantong Third People's Hospital, Nantong University, Jiangsu, China.
Xiao-Hong
XH
Zhu
Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Jiangsu, China.
Yan-Mei
YM
Liu
Center for Liver Diseases, Nantong Third People's Hospital, Nantong University, Jiangsu, China. shaojianguo4144@163.com.
Jian-Guo
JG
Shao
D065290:Acute-On-Chronic Liver Failure / Q000097:blood / Q000628:therapy*; D000328:Adult; D000368:Aged; D000066491:Clinical Decision-Making / Q000379:methods*; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood / Q000628:therapy*; D006801:Humans; D019164:Liver, Artificial; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012044:Regression Analysis; D012189:Retrospective Studies; D019564:Unnecessary Procedures; D055815:Young Adult
Acute-on-chronic liver failure; Decision curve analysis; Hepatitis B virus; Logistic regression model; Model for end-stage liver disease