Teerasarntipan T, Thanapirom K, Chaiteerakij R, Komolmit P, Treeprasertsuk S. Validation of prognostic scores for predicting acute liver failure and in-hospital death in patients with dengue-induced severe hepatitis. World J Gastroenterol 2024; 30(45): 4781-4790 [DOI: 10.3748/wjg.v30.i45.4781]
Corresponding Author of This Article
Sombat Treeprasertsuk, MD, PhD, Professor, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand. battan5410@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
Tongluk Teerasarntipan, Kessarin Thanapirom, Roongruedee Chaiteerakij, Piyawat Komolmit, Sombat Treeprasertsuk, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Author contributions: Teerasarntipan T designed the study, collected and analyzed the data, and drafted the manuscript; Thanapirom K, Chaiteerakij R, and Komolmit P assisted in manuscript drafting; Treeprasertsuk S supervised the study, contributed to data analysis, and assisted in manuscript drafting; all authors read and approved the final manuscript.
Supported by the Fatty Liver Unit, Foundation of the Faculty of Medicine, Chulalongkorn University.
Institutional review board statement: The study was reviewed and approved by the ethics committee of the Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (IRB 326/63).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sombat Treeprasertsuk, MD, PhD, Professor, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand. battan5410@gmail.com
Received: March 20, 2024 Revised: September 10, 2024 Accepted: October 14, 2024 Published online: December 7, 2024 Processing time: 238 Days and 0.7 Hours
Abstract
BACKGROUND
Acute liver failure (ALF) in dengue is rare but fatal. Early identification of patients who are at risk of ALF is the key strategy to improve survival.
AIM
To validate prognostic scores for predicting ALF and in-hospital mortality in dengue-induced severe hepatitis (DISH).
METHODS
We retrospectively reviewed 2532 dengue patients over a period of 16 years (2007-2022). Patients with DISH, defined as transaminases > 10 times the normal reference level and DISH with subsequent ALF, were included. Univariate regression analysis was used to identify factors associated with outcomes. Youden’s index in conjunction with receiver operating characteristic (ROC) analysis was used to determine optimal cut-off values for prognostic scores in predicting ALF and in-hospital death. Area under the ROC (AUROC) curve values were compared using paired data nonparametric ROC curve estimation.
RESULTS
Of 193 DISH patients, 20 developed ALF (0.79%), with a mortality rate of 60.0%. International normalized ratio, bilirubin, albumin, and creatinine were independent predictors associated with ALF and death. Prognostic scores showed excellent performance: Model for end-stage liver disease (MELD) score ≥ 15 predicted ALF (AUROC 0.917, sensitivity 90.0%, specificity 88.4%) and ≥ 18 predicted death (AUROC 0.823, sensitivity 86.9%, specificity 89.1%); easy albumin-bilirubin (ALBI) score ≥ -30 predicted ALF and death (ALF: AUROC 0.835, sensitivity80.0%, specificity 72.2%; death: AUROC 0.808, sensitivity 76.9%, specificity 69.3%); ALBI score ≥ -2 predicted ALF and death (ALF: AUROC 0.806, sensitivity 80.0%, specificity 77.4%; death: AUROC 0.799, sensitivity 76.9%, specificity 74.3%). Platelet-ALBI score also showed good performance in predicting ALF and death (AUROC = 0.786 and 0.699, respectively). MELD and EZ-ALBI scores had similar performance in predicting ALF (Z = 1.688, P = 0.091) and death (Z = 0.322, P = 0.747).
CONCLUSION
MELD score is the best predictor of ALF and death in DISH patients. EZ-ALBI score, a simpler yet effective score, shows promise as an alternative prognostic tool in dengue patients.
Core Tip: Although acute liver failure (ALF) from dengue infection is rare, its consequences are severe, often resulting in high mortality. Timely identification of at-risk individuals and prompt intervention are crucial for optimizing clinical outcomes. Parameters such as international normalized ratio, bilirubin, albumin, and creatinine were identified to be independent predictors associated with ALF and mortality. Incorporating these parameters into prognostic models, the model for end-stage liver disease score was the most reliable predictor of ALF and mortality in dengue-infected patients. Additionally, the easy albumin-bilirubin score, a simpler metric, exhibited excellent predictive performance, indicating its potential as an alternative prognostic tool in this patient population.
