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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