首页|A Prognostic Nomogram with High Accuracy Based on 2D-SWE in Patients with Acute-on-chronic Liver Failure

A Prognostic Nomogram with High Accuracy Based on 2D-SWE in Patients with Acute-on-chronic Liver Failure

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Background and Aims: Acute-on-chronic liver failure (ACLF) is associated with very high mortality. Accurate pre-diction of prognosis is critical in navigating optimal treat-ment decisions to improve patient survival. This study was aimed to develop a new nomogram integrating two-dimen-sional shear wave elastography (2D-SWE) values with other independent prognostic factors to improve the precision of predicting ACLF patient outcomes. Methods: A total of 449 consecutive patients with ACLF were recruited and random-ly allocated to a training cohort (n=315) or a test cohort (n=134). 2D-SWE values, conventional ultrasound features, laboratory tests, and other clinical characteristics were in-cluded in univariate and multivariate analysis. Factors with prognostic value were then used to construct a novel prog-nostic nomogram. Receiver operating curves (ROCs) were generated to evaluate and compare the performance of the novel and published models including the Model for End-Stage Liver Disease (MELD), MELD combined with sodium (MELD-Na), and Jin's model. The model was validated in a prospective cohort (n=102). Results: A ACLF prognostic nomogram was developed with independent prognostic fac-tors, including 2D-SWE, age, total bilirubin (TB), neutro-phils (Neu), and the international normalized ratio (INR). The area under the ROC curve (AUC) was 0.849 for the new model in the training cohort and 0.861 in the prospec-tive validation cohort, which were significantly greater than those for MELD (0.758), MELD-Na (0.750), and Jin's model (0.777, all p <0.05). Calibration curve analysis revealed good agreement between the predicted and observed prob-abilities. The new nomogram had superior overall net ben-efit and clinical utility. Conclusions: We established and validated a 2D-SWE-based noninvasive nomogram to pre-dict the prognosis of ACLF patients that was more accurate than other prognostic models.

Acute-on-chronic liver failureTwo-dimensional shear wave elas-tographyHepatitis B virusPrognosis

Lili Wu、Jieyang Jin、Taicheng Zhou、Yuankai Wu、Xinhua Li、Xiangyong Li、Jie Zeng、Jinfen Wang、Jie Ren、Yutian Chong、Rongqin Zheng

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Department of Medical Ultrasonics,Third Affiliated Hospital of Sun Yat-Sen University,Guangdong Key Laboratory of Liver Disease Research,Guangzhou,Guangdong,China

Department of Gastroenterological Surgery and Hernia Center,Sixth Affiliated Hospital of Sun Yat-Sen University,Guangdong Institute of Gastroenterology,Guangdong Provincial Key Labora-tory of Colorectal and Pelvic Floor Diseases,Supported by National Key Clinical Discipline,Guangzhou,Guangdong,China

Department of Infectious Diseases,Third Affiliated Hospital of Sun Yat-Sen University,Guangzhou,Guangdong,China

国家自然科学基金National Natural Science Foundation of the Third Affiliated Hospital of Sun Yat-Sen University

818278022020GZRPYQN17

2022

10.14218/JCTH.2021.00278

临床与转化肝病杂志(英文版)

临床与转化肝病杂志(英文版)

ISSN：
年,卷(期)：2022.10(5)
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