Classification and regression tree analysis of acute-on-chronic hepatitis B liver failure: Seeing the forest for the trees.
At present, there is no ideal model for predicting the short-term outcome of patients with acute-on-chronic hepatitis B liver failure (ACHBLF). This study aimed to establish and validate a prognostic model by using the classification and regression tree (CART) analysis. A total of 1047 patients from two separate medical centres with suspected ACHBLF were screened in the study, which were recognized as derivation cohort and validation cohort, respectively. CART analysis was applied to predict the 3-month mortality of patients with ACHBLF. The accuracy of the CART model was tested using the area under the receiver operating characteristic curve, which was compared with the model for end-stage liver disease (MELD) score and a new logistic regression model. CART analysis identified four variables as prognostic factors of ACHBLF: total bilirubin, age, serum sodium and INR, and three distinct risk groups: low risk (4.2%), intermediate risk (30.2%-53.2%) and high risk (81.4%-96.9%). The new logistic regression model was constructed with four independent factors, including age, total bilirubin, serum sodium and prothrombin activity by multivariate logistic regression analysis. The performances of the CART model (0.896), similar to the logistic regression model (0.914, P=.382), exceeded that of MELD score (0.667, P<.001). The results were confirmed in the validation cohort. We have developed and validated a novel CART model superior to MELD for predicting three-month mortality of patients with ACHBLF. Thus, the CART model could facilitate medical decision-making and provide clinicians with a validated practical bedside tool for ACHBLF risk stratification.
Department of Hepatology, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.
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0000-0002-5070-3834
KQ
Shi
Department of Cardiology, Jinhua Municipal Hospital, Jinhua, China.
Y-Y
YY
Zhou
Department of Infectious Diseases, Ningbo No. 2 Hospital, Ningbo, China.
H-D
HD
Yan
Department of Intensive Care Unit, Tianjin Infectious Disease Hospital, Tianjin, China.
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H
Li
Department of Hepatology, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.
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FL
Wu
Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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YY
Xie
Global Medicines Development, AstraZeneca R&D, Loughborough, UK.
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M
Braddock
Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
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XY
Lin
Department of Hepatology, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.|Institute of Hepatology, Wenzhou Medical University, Wenzhou, China.
M-H
0000-0003-4984-2631
MH
Zheng
D065290:Acute-On-Chronic Liver Failure / Q000401:mortality* / Q000473:pathology*; D000328:Adult; D000368:Aged; D003661:Decision Support Techniques; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis
acute-on-chronic hepatitis B liver failure; classification and regression tree; cohort study; model for end-stage liver disease; prognostic prediction