title: Development and validation of a prognostic nomogram for acute-on-chronic hepatitis B liver failure.
abstract: OBJECTIVE
  Determining individual risk of short-term mortality in patients with acute-on-chronic hepatitis B liver failure (ACHBLF) is a difficult task. We aimed to develop and externally validate a prognostic nomogram for ACHBLF patients.
  
  
  METHODS
  The nomogram was built to estimate the probability of 30-day, 60-day, 90-day, and 60-month survival based on an internal cohort of 246 patients with ACHBLF. The predictive accuracy and discriminative ability of nomogram were determined by a concordance index (C-index), calibration curve, and time-dependent receiver operating characteristics (tdROC), comparing with model for end-stage liver disease (MELD) score. The results were validated using bootstrap resampling and an external cohort of 138 patients. Furthermore, we plotted decision curves to evaluate the clinical usefulness of nomogram.
  
  
  RESULTS
  Independent factors derived from multivariable Cox analysis of training cohort to predict mortality were age, total bilirubin, serum sodium, and prothrombin activity, which were all assembled into nomogram. The calibration curves for probability of survival showed optimal agreement between nomogram prediction and actual observation. The C-index of nomogram was higher than that of MELD score for predicting survival (30-day, 0.809 vs 0.717, P < 0.001; 60-day, 0.792 vs 0.685, P < 0.001; 90-day, 0.779 vs 0.678, P < 0.001; 6-month, 0.781 vs 0.677, P < 0.001). Additionally, tdROC and decision curves also showed that nomogram was superior to MELD score. The results were confirmed in validation cohort.
  
  
  CONCLUSIONS
  The prognostic nomogram provided an individualized risk estimate of short-term survival in patients with ACHBLF, offering to clinicians to improve their abilities to assess patient prognosis.
authors.affiliation: Department of Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Ke-Qing
authors.identifier: http://orcid.org/0000-0002-5070-3834
authors.initials: KQ
authors.lastname: Shi
authors.affiliation: Department of Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Yi-Jing
authors.initials: YJ
authors.lastname: Cai
authors.affiliation: Department of Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Lin
authors.affiliation: Department of Infection and Liver Diseases, Ningbo First Hospital, Ningbo, China.
authors.forename: Jin-Zhong
authors.initials: JZ
authors.lastname: Dong
authors.affiliation: Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou, China.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Wu
authors.affiliation: Department of Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Wang
authors.affiliation: Department of Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Song
authors.affiliation: Department of Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Yu-Qun
authors.initials: YQ
authors.lastname: Wang
authors.affiliation: Department of Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Yong-Ping
authors.initials: YP
authors.lastname: Chen
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000401:mortality*; D000328:Adult; D000367:Age Factors; D001663:Bilirubin; D002138:Calibration; D015331:Cohort Studies; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011379:Prognosis; D016016:Proportional Hazards Models; D011516:Prothrombin; D012372:ROC Curve; D012306:Risk; D012680:Sensitivity and Specificity; D012964:Sodium / Q000097:blood; D015996:Survival Rate; D013997:Time Factors
chemical_list: D011516:Prothrombin; D012964:Sodium; D001663:Bilirubin
keywords: acute-on-chronic hepatitis B liver failure; decision curves; nomogram; prediction; time-dependent receiver operating characteristics