Value of Chinese Group on the Study of Severe Hepatitis B-acute-on-chronic liver failure Ⅱ score combined with serum alpha-fetoprotein in evaluating the prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure treated with artifi
Objective To explore the value of Chinese Group on the Study of Severe Hepatitis B-acute-on-chronic live failure(COSSH-ACLF Ⅱ)score combined with serum alpha-fetoprotein(AFP)in predicting the prognosis of hepatitis B virus-associated acute-on-chronic liver failure(HBV-ACLF)patients treated with artificial liver therapy.Methods A total of 174 HBV-ACLF patients who underwent initial artificial liver therapy admitted to the Department of Infectious Diseases,The First Hospital of Shanxi Medical University,from March 2023 to April 2024 were enrolled.The model for end-stage liver disease(MELD),MELD combined with serum sodium(MELD-Na),MELD 3.0,and COSSH-ACLF Ⅱ scores were calculated.The 174 patients were divided into a training set and a validation set at a 7∶3 ratio.Based on follow-up survival outcomes,the patients in the training and validation sets were classified into survival and non-survivor groups.Laboratory tests,serum AFP levels,and various model scores were compared between the two groups.Logistic regression analysis was used to identify prognostic factors in HBV-ACLF patients,and a nomogram model was constructed.The predictive value of COSSH-ACLF Ⅱ score combined with serum AFP levels for follow-up deadline(June 14,2024)prognosis and survival outcomes at 30,60,and 90 days post-artificial liver therapy in HBV-ACLF patients was assessed using receiver operating characteristic(ROC)curves.Statistical comparisons were performed using the independent sample t test and Mann-Whitney U test.Results Among the 174 HBV-ACLF patients,122 were in the training set(80 survivors,42 non-survivors)and 52 were in the validation set(17 survivors,35 non-survivors).In the training set,age,neutrophil count,urea,MELD score,MELD-Na score,MELD 3.0 score,COSSH-ACLF Ⅱ score,and AFP levels in the non-survivor group were significantly higher than those in the survivor group(t=2.82,Z=-3.27,Z=-2.65,t=2.16,t=2.60,t=2.33,t=4.56 and Z=-4.71,respectively,all P＜0.05).In the validation set,albumin,COSSH-ACLF Ⅱ score,and AFP levels in the non-survivor group were significantly higher than those in the survivor group(Z=-2.20,t=2.78 and Z=-2.55,respectively,all P＜0.05).Serum AFP(odds ratio(OR)=1.005,95％confidence interval(95％CI)1.001 to 1.008,P=0.010)and COSSH-ACLF Ⅱ score(OR=2.140,95％CI 1.410 to 3.240,P＜0.001)were independent risk factors for the prognosis of HBV-ACLF patients.A nomogram predicting the prognosis of HBV-ACLF patients was constructed using serum AFP and the COSSH-ACLF Ⅱ score,with a C-index of 0.816 and a well-fitted calibration curve.In the training set,the areas under the curve(AUC)for COSSH-ACLF Ⅱ score,serum AFP levels,and their combined prediction of prognosis were 0.737,0.760 and 0.816,respectively,and the AUCs for COSSH-ACLF Ⅱ score combined with serum AFP were 0.805,0.797 and 0.739,respectively,for predicting the prognosis at 30,60,and 90 days post-artificial liver therapy.In the validation set,the AUCs for COSSH-ACLF Ⅱ score,serum AFP levels,and their combined prediction of prognosis were 0.701,0.720 and 0.785,respectively,and the AUCs for COSSH-ACLF Ⅱ score combined with serum AFP were 0.729,0.684 and 0.624,respectively,for predicting prognosis at 30,60,and 90 days post-artificial liver therapy.Conclusions Serum AFP and the COSSH-ACLF Ⅱ score are independent risk factors for the prognosis of HBV-ACLF patients.Patients with poor prognosis may have higher COSSH-ACLF Ⅱ scores and serum AFP levels,and the combination of COSSH-ACLF Ⅱ score with serum AFP levels can improve the accuracy of predicting short-term prognosis in these patients.
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