Zheng et al developed a logistic regression model for predicting 3-month mortality for a patient with hepatitis B virus (HBV) causing acute-on-chronic liver failure. This can help to identify a patient who may benefit from more aggressive management. The authors are from Wenzhou Medical College, Shandong University, Tianjin Infectious Disease Hospital and Wenzhou Third People's Hospital in China.
Patient selection: acute-on-chronic liver failure in a patient with chronic HBV infection
Outcome: 3-month mortality
Criteria for acute-on-chronic liver failure:
(1) chronic HBV infection
(2) jaundice
(3) coagulopathy
(4) ascites and/or encephalopathy within 4 weeks
Parameters:
(1) hepatic encephalopathy
(2) hepatorenal syndrome (HRS)
(3) cirrhosis
(4) HBeAg
(5) PTA to age ratio (PTA is prothrombin activity, in percent)
|
Parameter
|
Finding
|
Points
|
|
hepatic encephalopathy
|
absent
|
0
|
|
|
present
|
0.772
|
|
hepatorenal syndrome
|
absent
|
0
|
|
|
present
|
2.279
|
|
cirrhosis
|
absent
|
0
|
|
|
present
|
0.850
|
|
HBeAg
|
absent
|
0
|
|
|
present
|
1.056
|
|
PTA to age ratio
|
|
-2.117 * (ratio)
|
X =
= SUM(points for all 5 parameters) - 1.343
probability of 3-month mortality =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curves is 0.84.
