Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2017; 23(40): 7303-7309
Published online Oct 28, 2017. doi: 10.3748/wjg.v23.i40.7303
Modified model for end-stage liver disease improves short-term prognosis of hepatitis B virus-related acute-on-chronic liver failure
Wei Chen, Jia You, Jing Chen, Qi Zheng, Jia-Ji Jiang, Yue-Yong Zhu
Wei Chen, Jia You, Jing Chen, Qi Zheng, Jia-Ji Jiang, Yue-Yong Zhu, Center for Liver Diseases, the First Affiliated Hospital, Fujian Medicine University, Fuzhou 350005, Fujian Province, China
Author contributions: Chen W performed the majority of the research around this topic and wrote the manuscript; You J and Chen J were involved in the field study, analyzed the data and gave interpretations; Zheng Q and Jiang JJ performed the field study and provided valuable discussion and support; and Zhu YY was responsible for overall study concept and design, and revised the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of the First Affiliated Hospital of Fujian Medicine University.
Informed consent statement: Written consent was obtained from all study participants, or the local guardian, in their first medical examination.
Conflict-of-interest statement: The authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yue-Yong Zhu, MD, Professor, Center for Liver Diseases, the First Affiliated Hospital, Fujian Medicine University, Fuzhou 350005, Fujian Province, China. zhuyueyong@fjmu.edu.cn
Telephone: +86-591-87982053 Fax: +86-591-87982053
Received: June 27, 2017
Peer-review started: July 11, 2017
First decision: July 27, 2017
Revised: August 15, 2017
Accepted: September 5, 2017
Article in press: September 5, 2017
Published online: October 28, 2017
Processing time: 123 Days and 22 Hours
Abstract
AIM

To investigate whether the short-term prognosis of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) could be improved by using a modified model for end-stage liver disease (MELD) including serum lactate.

METHODS

This clinical study was conducted at the First Affiliated Hospital, Fujian Medicine University, China. From 2009 to 2015, 236 patients diagnosed with HBV-related ACLF at our center were recruited for this 3-month follow-up study. Demographic data and serum lactate levels were collected from the patients. The MELD scores with or without serum lactate levels from survival and non-survival groups were recorded and compared.

RESULTS

Two hundred and thirty-six patients with HBV-ACLF were divided into two groups: survival group (S) and non-survival group (NS). Compared with the NS group, the patients in survival the S group had a significantly lower level of serum lactate (3.11 ± 1.98 vs 4.67 ± 2.43, t = 5.43, P < 0.001) and MELD score (23.33 ± 5.42 vs 30.37 ± 6.58, t = 9.01, P = 0.023). Furthermore, serum lactate level was positively correlated with MELD score (r = 0.315, P < 0.001). Therefore, a modified MELD including serum lactate was developed by logistic regression analysis (0.314 × lactate + 0.172 × MELD - 5.923). In predicting 3-month mortality using the MELD-LAC model, the patients from the S group had significantly lower baseline scores (-0.930 ± 1.34) when compared with those from the NS group (0.771 ± 1.32, t = 9.735, P < 0.001). The area under the receiver operating characteristic curve (AUROC) was 0.859 calculated by using the MELD-LAC model, which was significantly higher than that calculated by using the lactate level (0.790) or MELD alone (0.818). When the cutoff value was set at -0.4741, the sensitivity, specificity, positive predictive value and negative predictive value for predicting short-term mortality were 91.5%, 80.10%, 94.34% and 74.62%, respectively. When the MELD-LAC scores at baseline level were set at -0.5561 and 0.6879, the corresponding mortality rates within three months were 75% and 90%, respectively.

CONCLUSION

The short-term prognosis of HBV-related ACLF was improved by using a modified MELD including serum lactate from the present 6-year clinical study.

Keywords: Hepatitis B virus; Liver failure; Model for end-stage liver disease score; Prognosis; Serum lactate level

Core tip: This is a retrospective study to evaluate the short-term prognosis of hepatitis B virus (HBV)-acute-on-chronic liver failure (ACLF). Two hundred and thirty-six patients with HBV-ACLF were divided into two groups: survival group (S) and non-survival group (NS). In predicting 3-mo mortality using the model for MELD-LAC model, patients from the S group had significantly lower baseline scores compared with those from NS group using model for end-stage liver disease (MELD)-LAC model. AUROC was 0.859 calculated by using the MELD-LAC model, which was significantly higher than those calculated by using the lactate level (0.790) or MELD alone (0.818). The short-term prognosis of HBV-ACLF was improved by using a modified MELD including serum lactate from the present 6-year clinical study.