Development and validation of a new prognostic model for patients with acute-on-chronic liver failure in intensive care unit

Figure 1 Forest plot showing independent risk factors for 28-day mortality in patients with acute-on-chronic liver failure. MAP: Mean arterial pressure; WBC: White blood cell; TB: Total bilirubin; INR: International normalized ratio.

Figure 2 Receiver operating characteristic curve of prognostic scores for mortality in derivation set. A: Receiver operating characteristic (ROC)curve for 28-day mortality; B: ROC curve for 90-day mortality. AUC: Area under the curve; MIMIC: Medical Information Mart for Intensive Care; MELD: Model for End-stage Liver; CLIF-C: Chronic Liver Failure Consortium.

Figure 3 Calibration ability of prognostic scores for mortality in derivation set. A-D: Calibration for 28-day mortality [Medical Information Mart for Intensive Care (MIMIC) acute-on-chronic liver failure (ACLF; A), Chronic Liver Failure Consortium (CLIF-C) ACLF (B), Model for End-stage Liver (MELD, C), and MELD-Na (D)]; E-H: Calibration for 90-day mortality [MIMIC ACLF (E), CLIF-C ACLF (F), MELD (G), and MELD-Na (H)].

Figure 4 Decision curve analysis of prognostic scores for mortality in derivation set of Medical Information Mart for Intensive Care cohort. A: Decision curve analysis (DCA) for 28-day mortality; B: DCA for 90-day mortality. MIMIC: Medical Information Mart for Intensive Care; MELD: Model for End-stage Liver; CLIF-C: Chronic Liver Failure Consortium; ACLF: Acute-on-chronic liver failure.

Figure 5 Survival analysis based on Medical Information Mart for Intensive Care acute-on-chronic liver failure score for mortality in derivation set of Medical Information Mart for Intensive Care cohort. A: Survival analysis for 28-day mortality; B: Survival analysis for 90-day mortality. MIMIC: Medical Information Mart for Intensive Care; ACLF: Acute-on-chronic liver failure.

Figure 6 Receiver operating characteristic curve of prognostic scores for mortality in validation set of Medical Information Mart for Intensive Care cohort. A: Receiver operating characteristic (ROC) curve for 28-day mortality; B: ROC curve for 90-day mortality. AUC: Area under the curve; MIMIC: Medical Information Mart for Intensive Care; MELD: Model for End-stage Liver; CLIF-C: Chronic Liver Failure Consortium; ACLF: Acute-on-chronic liver failure.

Figure 7 Calibration ability of prognostic scores for mortality in validation set of Medical Information Mart for Intensive Care cohort. A-D: Calibration for 28-day mortality [Medical Information Mart for Intensive Care (MIMIC) acute-on-chronic liver failure (ACLF, A), Chronic Liver Failure Consortium (CLIF-C) ACLF (B), Model for End-stage Liver (MELD, C), and MELD-Na (D)]; E-H: Calibration for 90-day mortality [MIMIC ACLF (E), CLIF-C ACLF (F), MELD (G), and MELD-Na (H)].

Figure 8 Decision curve analysis of prognostic scores for mortality in validation set of Medical Information Mart for Intensive Care cohort. A: Decision curve analysis (DCA) for 28-day mortality; B: DCA for 90-day mortality. MIMIC: Medical Information Mart for Intensive Care; MELD: Model for End-stage Liver; CLIF-C: Chronic Liver Failure Consortium; ACLF: Acute-on-chronic liver failure.

Figure 9 Internal validation of Medical Information Mart for Intensive Care acute-on-chronic liver failure score-based risk stratification. A: Risk stratification for 28-day mortality in patients with acute-on-chronic liver failure (ACLF); B: Risk stratification for 90-day mortality in patients with ACLF. MIMIC: Medical Information Mart for Intensive Care; ACLF: Acute-on-chronic liver failure.

Figure 10  External validation of Medical Information Mart for Intensive Care acute-on-chronic liver failure model in the Second Hospital of Hebei Medical University cohort. A: Receiver operating characteristic (ROC) curve for 28-day mortality; B: ROC curve for 90-day mortality; C: Calibration curve for 28-day mortality; D: Calibration curve for 90-day mortality; E: Decision curve analysis for 28-day mortality; F: Decision curve analysis for 90-day mortality; G: Survival analysis for 28-day mortality; H: Survival analysis for 90-day mortality. AUC: Aera under the curve; ROC: Receiver operating characteristic; MIMIC: Medical Information Mart for Intensive Care; MELD: Model for End-stage Liver; CLIF-C: Chronic Liver Failure Consortium; ACLF: Acute-on-chronic liver failure.

Figure 11  Receiver operating characteristic curves of prognostic scores for mortality in electronic intensive care unit cohort. A: Receiver operating characteristic (ROC) curve for In-intensive care unit mortality; B: ROC curve for In-hospital mortality. ICU: Intensive care unit; AUC: Aera under the curve; ROC: Receiver operating characteristic; MIMIC: Medical Information Mart for Intensive Care; MELD: Model for End-stage Liver; CLIF-C: Chronic Liver Failure Consortium; ACLF: Acute-on-chronic liver failure.

Figure 12  Calibration curves of prognostic scores for mortality in electronic intensive care unit cohort. A-E: In-intensive care unit mortality [Medical Information Mart for Intensive Care (MIMIC) acute-on-chronic liver failure (ACLF, A), Chronic Liver Failure Consortium (CLIF-C) ACLF (B), Model for End-stage Liver (MELD, C), MELD-Na (D) and APACHE (E)]; F-J: In-Hospital mortality [MIMIC ACLF (F), CLIF-C ACLF (G), MELD (H), MELD-Na (I) and APACHE (J)]. ICU: Intensive care unit; OS: Overall survival.

Figure 13  Decision curve analysis of prognostic scores for mortality in electronic intensive care unit cohort. A: In-intensive care unit mortality; B: In-Hospital mortality. MIMIC: Medical Information Mart for Intensive Care; MELD: Model for End-stage Liver; CLIF-C: Chronic Liver Failure Consortium; ACLF: Acute-on-chronic liver failure.

Figure 14  The online calculator based on Medical Information Mart for Intensive Care acute-on-chronic liver failure prognostic model. MIMIC: Medical Information Mart for Intensive Care; ACLF: Acute-on-chronic liver failure; INR: International normalized ratio.