Score model for predicting acute-on-chronic liver failure risk in chronic hepatitis B

Table 1 Baseline characteristics of the study cohort

Variables	Total	Non-ACLF	ACLF	P value
	(n = 382)	(n = 330)	(n = 52)
Demographics
Sex
Female	60 (15.7)	49 (14.8)	11 (21.2)	0.2452
Male	322 (84.3)	281 (85.2)	41 (78.8)
Age (yr)
< 40	226 (59.2)	207 (62.7)	19 (36.5)	< 0.0012
≥ 40	156 (40.8)	123 (37.3)	33 (63.5)
Underlying disease
HBV carriers	98 (25.7)	93 (28.2)	5 (9.6)	0.0012
CHB	255 (58.9)	217 (65.8)	38 (73.1)
Compensatory cirrhosis	29 (7.6)	20 (6.0)	9 (17.3)
Biochemical indicators
ALT (U/L)	746.9 (338.1, 1229.0)	754.2 (361.6, 1215.7)	644.4 (324.9, 1430.6)	0.9243
AST (U/L)	448.0 (217.7, 836.1)	432.5 (216.1, 806.9)	529.4 (273.8, 960.9)	0.0913
TBil (μmol/L)
< 171	234 (61.3)	210 (63.6)	24 (46.2)	0.0162
≥ 171	148 (38.7)	120 (36.4)	28 (53.8)
PTA (%)
> 60	184 (48.1)	181 (54.8)	3 (5.8)	< 0.0012
50.1-60	124 (32.5)	100 (30.3)	24 (46.1)
40-50	74 (19.4)	49 (14.9)	25 (48.1)
ALB4 (g/L)	37.2 ± 4.8	37.4 ± 4.6	36.0 ± 5.3	0.0431
CHE (U/L)	4801.8 ± 1645.5	4864.2 ± 1559.1	4666.2 ± 1840.4	0.4201
K (mmol/L)	3.91 ± 0.44	3.92 ± 0.44	3.90 ± 0.41	0.8261
Na (mmol/L)	138.7 ± 2.9	138.8 ± 2.9	137.6 ± 2.8	0.0041
Cr5 (μmol/L)	67.6 ± 14.5	67.6 ± 12.7	67.1 ± 22.7	0.8131
Virology indicators
HBeAg6 (IU/mL)
Negative	88 (23.0)	73 (22.1)	15 (28.8)	0.3682
Positive	280 (73.3)	243 (73.6)	37 (71.2)
HBV DNA (copies/mL)
< 106	153 (40.1)	144 (43.6)	9 (17.3)	< 0.0012
106-107	104 (27.2)	93 (28.2)	11 (21.2)
> 107	125 (32.7)	93 (28.2)	32 (61.5)

Data are presented as mean ± SD, n (%), or median (interquartile range).

¹t test;

²χ² test or Fisher’s exact test;

³Mann-Whitney U test;

⁴One missing data;

⁵Eight missing data;

⁶Fourteen missing data. ACLF: Acute-on-chronic liver failure; CHB: Chronic hepatitis B; ALB: Albumin; ALT: Alanine transaminase; AST: Aspartate transaminase; HBV: Hepatitis V virus; HBeAg: Hepatitis B e antigen; TBil: Total bilirubin; PTA: Prothrombin activity; ALB: Albumin; CHE: Cholinesterase; K: Potassium; Na: Sodium; Cr: Creatinine.

Table 2 Forward multivariate logistic regression analysis of significant variables

Variables	Odds ratio	95%CI		P value
		Lower	Upper
Age (yr)
< 40	Reference
≥ 40	2.859	1.399	5.840	0.004
TBil (μmol/L)
< 171	Reference
≥ 171	2.894	1.408	5.946	0.004
PTA (%)
> 60	Reference
50.1-60	10.19	2.894	35.882	< 0.001
40-50	26.285	7.311	94.499	< 0.001
HBV DNA (copies/mL)
< 106	Reference
106-107	1.929	0.691	5.389	0.210
> 107	7.15	2.918	17.523	< 0.001

HBV: Hepatitis V virus; CI: Confidence interval; PTA: Prothrombin activity; TBil: Total bilirubin.

Table 3 Regression coefficients and integer risk scores of acute-on-chronic liver failure predictors estimated from the derivation set

ACLF predictors	Regression coefficient	P value	Risk score
Age ≥ 40 (yr)	1.128	0.010	1
TBil ≥ 171 (μmol/L)	1.237	0.007	1
PTA (%)
50.1-60	2.158	0.001	2
40-50	2.868	< 0.001	3
HBV DNA > 107 (copies/mL)	1.946	< 0.001	2
Overall risk level	ACLF rate		Total score
Low risk	0%-4.7%		0-3
High risk	26.0%-68.8%		4-7

The regression coefficient 1.128 is considered as one risk point. ACLF: Acute-on-chronic liver failure; HBV: Hepatitis V virus; PTA: Prothrombin activity; TBil: Total bilirubin.