Description

Li et al reported an update to the COSSH-ACLF score for evaluating a patient with hepatitis B virus-related acute-on-chronic liver failure (ACLF). This can help to identify a patient who may benefit from more aggressive management. The authors are from the Chinese Group on the Study of Severe Hepatitis B (COSSH).

 


Patient selection: acute-on-chronic liver failure related to HBV

 

Parameters:

(1) INR

(2) hepatic encephalopathy score

(3) absolute neutrophil count in 10^9/L

(4) serum total bilirubin in µmol/L

(5) serum urea in mmol/L

(6) age in years

 

Parameter

Finding

Points

INR

 

1.649 * LN(INR)

hepatic encephalopathy

0

0.457

 

1 or 2

2 * 0.457

 

3 or 4

3 * 0.457

neutrophil count

 

0.425 * LN(ANC)

total bilirubin

 

0.396 * LN(bilirubin)

urea

 

0.576 * LN(urea)

age

 

0.033 * (age

 

score =

= SUM(points for all of the parameters)

 

Days

Clx

beta

28

0.0001705272

1.022168

90

0.0002945163

1.019304

 

Y =

= (Clx) * EXP((beta)*(score))

 

probability of death in x days =

= 1 - EXP((-1) * Y)

 

Score

28-Day Mortality

90-Day Mortality

< 7.4

8%

19%

7.4 to 8.4

50%

66%

> 8.4

76%

88%

 

Performance:

• The area under the ROC curve for 28-day mortality is 0.826.

• The area under the ROC curve for 90-day mortality is 0.809.


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