BackgroundEarly identification of hepatitis B virus‐related acute‐on‐chronic liver failure (HBV‐ACLF) holds crucial importance in guiding clinical management and reducing mortality. However, existing scoring systems often overlook patient's underlying clinical condition, which significantly impacts prognosis.AimsUse the age‐adjusted Charlson comorbidity index (aCCI) to evaluate the patient's complications to develop a more precise model for predicting transplant‐free mortality in HBV‐ACLF patients.MethodsNine hundred and six patients were included for investigation and were segregated into a training cohort and a temporal validation cohort according to the chronological order of admission in a ratio of 7:3. In the training cohort, univariate analysis, logistic regression analysis and LASSO regression analysis were used to construct a prognostic model and it was subsequently validated in a temporal validation cohort and an external validation cohort.ResultsWe found total bilirubin, neutrophils, international normalised ratio and aCCI exhibited significant associations with 28‐day transplant‐free mortality and established a novel prognostic model, named aCCI‐HBV‐ACLF. The model demonstrated strong predictive performance, with area under the receiver operating characteristic curve (ROC) values of 0.859 for 28‐day mortality, 0.822 for 90‐day mortality. In the temporal validation cohort, aCCI‐HBV‐ACLF achieved area under the ROC values of 0.869 for 28‐day mortality and 0.850 for 90‐day mortality. In the external validation cohort, aCCI‐HBV‐ACLF had area under the ROC values of 0.868 for 28‐day mortality and 0.888 for 90‐day mortality.ConclusionsThis study proposes a new prognostic model, which achieved excellent predictive ability for 28−/90‐day transplant‐free mortality rates among patients with HBV‐ACLF.

中文翻译：

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aCCI-HBV-ACLF：乙型肝炎病毒相关慢加急性肝衰竭的新型预测模型


背景早期识别乙型肝炎病毒相关的慢加急性肝衰竭 （HBV-ACLF） 在指导临床管理和降低死亡率方面具有至关重要性。然而，现有的评分系统往往忽视患者的潜在临床状况，这会显着影响预后。目的使用年龄调整后的 Charlson 合并症指数 （aCCI） 来评估患者的并发症，以开发更精确的模型来预测 HBV-ACLF 患者的无移植死亡率。方法纳入 906 例患者进行调查，并根据入院时间顺序以 7：3 的比例分为训练队列和时间验证队列。在训练队列中，采用单变量分析、逻辑回归分析和 LASSO 回归分析构建预后模型，随后在时间验证队列和外部验证队列中进行了验证。结果我们发现总胆红素、中性粒细胞、国际标准化比值和 aCCI 与 28 天无移植死亡率呈显着关联，并建立了一个新的预后模型，命名为 aCCI-HBV-ACLF。该模型显示出强大的预测性能，28 天死亡率的受试者工作特征曲线下面积 （ROC） 值为 0.859,90 天死亡率为 0.822。在时间验证队列中，aCCI-HBV-ACLF 的 28 天死亡率和 90 天死亡率的 ROC 值下面积分别为 0.869 和 0.850。在外部验证队列中，aCCI-HBV-ACLF 的 28 天死亡率低于 ROC 值的面积为 0.868,90 天死亡率的面积低于 0.888。结论本研究提出了一种新的预后模型，该模型对 HBV-ACLF 患者 28 - /90 天无移植死亡率具有极好的预测能力。