The Predictive Value Of Different Prognostic Scoring Models In China For Of Patients With Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Objective: To explore independent factors affecting short-term prognosis in patients with Hepatitis B virus-related acute-onchronic liver failure(HBV-ACLF),To compare the predictive value of Model for end-stage liver disease(MELD)score,COSSH-ACLF Ⅱ score,COSSH-ACLF score,TPPM score,line chart score and artificial neural network(ANN)score for 28-day and 90-day prognosis of patients with HBV-ACLF.Methods: A total of 80 patients with HBV-ACLF who were hospitalized in the Department of Hepatology of our hospital from January 2018 to October 2022 were selected.General conditions and relevant laboratory data were collected after admission.MELD score,COSSH-ACLF Ⅱ score,COSSH-ACLF score,TPPM score,line graph score and ANN score were calculated according to laboratory detection indexes and clinical data.Through medical records and telephone follow-up,80 patients were divided into survival group and death group according to their survival conditions at28 days and 90 days after admission.SPSS21.0 was used to identify independent factors associated with 28-day and 90-day outcomes.Med Calc19.0.4 statistical software was used to plot MELD score,COSSH-ACLFⅡscore,COSSH-ACLF score,TPPM score,line graph score and ANN score.Receiver operating characteristic(ROC curve)to evaluate the value of each score in prognostic evaluation of HBV-ACLF patients.The area under cueve(AUC)curve was calculated respectively to compare the predictive value of each scoring model for the prognosis of HBV-ACLF patients.Results: 1.A total of 80 HBV-ACLF patients were included in this study,and 20(25%)died within 28 days.39 cases(48.75%)died within 90 days.2.The number of complications,total bilirubin,international normalized ratio,hepatic encephalopathy grade,neutrophil percentage,and serum sodium were all single factors affecting mortality at 28-day and 90-day(P<0.05).Serum sodium is an independent risk factor for the 28-day prognosis of HBV-ACLF patients,and total bilirubin is an independent risk factor for the90-day prognosis of HBV-ACLF patients.3.Corresponding efficacy can be obtained in patients with HBV-ACLF treated with artificial liver,but there is no significant statistical difference in this study,and its effect on clinical outcome of patients with HBV-ACLF needs to be further evaluated.4.All the six scoring models were effective for the 28-day and 90-day prognosis assessment of HBV-ACLF.For the 28-day prognosis of patients with HBV-ACLF,the AUC area of COSSH-ACLF score,COSSH-ACLFⅡscore and MELD score were all greater than 0.8,indicating that the three factors have high predictive value for the 28-day prognosis evaluation of patients with HBV-ACLF.The predictive value of the six scoring models for the 28-day prognosis of HBV-ACLF patients from high to low was:COSSH-ACLF Ⅱ score>COSSH-ACLF score> MELD score >Score of28-day line chart >28 days ANN rating>TPPM score.For the 90-day prognosis evaluation of HBV-ACLF patients,the AUC area of COSSH-ACLFⅡscore and MELD score was greater than 0.7,indicating that COSSH-ACLFⅡscore and MELD score have relatively high predictive value for the 90-day prognosis evaluation of HBV-ACLF patients.The prediction efficiency of the six scoring models for the 90-day prognosis of HBV-ACLF patients from high to low was: COSSH-ACLF Ⅱ score >MELD score >COSSH-ACLF score >90d line chart score >TPPM score >90d ANN score.Conclusion(s): COSSH-ACLF Ⅱ score,COSSH-ACLF score,MELD score,TPPM score,line chart score and ANN score model are all valuable for the 28-day and 90-day prognosis evaluation of HBV-ACLF patients.The prediction value of COSSH-ACLF Ⅱ score at two time nodes is the best.Serum sodium and total bilirubin are independent risk factors affecting the prognosis of HBV-ACLF patients at 28-day and 90-day,respectively.