title: A MELD-based nomogram for predicting 3-month mortality of patients with acute-on-chronic hepatitis B liver failure.
abstract: BACKGROUND
  Acute-on-chronic hepatitis B liver failure (ACHBLF) is associated with poor short-term prognosis. The aim of the present study was to construct and validate a model for end-stage liver disease (MELD)-based nomogram for the 3-month mortality estimation for patients with ACHBLF.
  
  
  METHODS
  A total of 551 patients with ACHBLF were prospectively enrolled from 2 independent medical centers and divided into 2 cohorts of training and validation, respectively. The 3-month mortality was recorded as the outcome. The MELD-based nomogram was constructed to predict the 3-month mortality for ACHBLF using the training group of 335 patients and validated using an independent cohort of 216 patients. The predictive capability of MELD-based nomogram was compared with the MELD score system by calibration analysis, receiver operating characteristics (ROC) and decision curve analysis in both training cohort and validation cohort.
  
  
  RESULTS
  Multivariate analysis suggested that age, serum sodium, and MELD score were independent prognostic indicators associated with the 3-month mortality for ACHBLF, and therefore used for developing the nomogram. In terms of calibration, the predicted survival by the MELD-based nomogram was found to be extremely in line with the observed 3-month mortality both in training cohort and validation cohort. Additionally, both ROC and decision curve analyses showed that the MELD-based nomogram was better than MELD, MELD-Na, MELDNa, and iMELD for ACHBLF prognosis prediction. The results were confirmed in the external cohort of validation.
  
  
  CONCLUSIONS
  The MELD-based nomogram provided a user-friendly, accurate and reproducible tool for predicting 3-month mortality of patients with ACHBLF.
authors.affiliation: Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Rui-Cong
authors.initials: RC
authors.lastname: Chen
authors.affiliation: Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Wang
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: Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Lin
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 Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Yi-Jing
authors.initials: YJ
authors.lastname: Cai
authors.affiliation: Department of Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. Electronic address: skochilly@163.com.
authors.forename: Ke-Qing
authors.initials: KQ
authors.lastname: Shi
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000401:mortality*; D002138:Calibration; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D015203:Reproducibility of Results
keywords: Acute-on-chronic hepatitis B liver failure; Calibration; Decision curve; Nomogram; Prediction; Receiver operating characteristics