| Background & Aims: To establish an effective prognostic nomogram for acute-on-chronic hepatitis B liver failure(ACHBLF).Methods: The study retrospectively collected clinical data of ACHBLF patients who admitted to the First Affiliated Hospital of Fujian Medical University from 2009 to2014. All patients were randomly divided into training cohort and validation cohort.Baseline comparisons between the two cohorts were performed using student’s t-test or Mann-Whitney test for continuous variables where appropriate and chi-square tests for categorical variables. The training cohort were divided into survival group and non-survival group. Univariate and multivariable COX proportional hazard analysis were used to recognize independent prognostic factors. Nomogram was established based on the results of multivariable analysis by R software. Area under the receiver-operating characteristic curve(AUC) and calibration curve were carried out to verify the predictive accuracy ability of the nomogram. Kaplan-Meier survival curve was used in survival analysis. The result was validated in a validation cohort.Results: A total of 304 patients were included in this study who were randomly assigned into a training cohort(n=203) and a validation cohort(n=101). At a median of 494 days(range 2-2454 days) of follow-up, there were 128 patients died and 3patients underwent liver transplant. The baseline characteristics between the training cohort and the validation cohort were not significantly different. We developed a new prognostic nomogram to predict 3-month mortality based on risk factors selected by multivariate analysis. Univariate analysis showed that age, total bilirubin, serum sodium, international normalized ratio, albumin, serum creatinine, ascites, infection,HE, upper gastrointestinal bleeding, liver to abdominal area ratio(LAAR) and model for end-stage liver disease(MELD) score differed significantly between survivors and those who died within three months. On the cox regression analysis, infection(HR1.814; 95% confidence interval [CI] 1.175-2.801), LAAR(HR 0.901; 95%CI0.870-0.934) and MELD score(HR 1.046; 95%CI 1.024-1.069) were independent risk factors for 3-months mortality. The nomogram consisted these three independent factors. The AUC of this nomogram for survival prediction was 0.853(95%CI 0.801-0.906), which was higher than that of MELD score(P=0.033). Good agreement of calibration plot for the probability of survival at 3-month was shown between the prediction by nomogram and actual observation. The cutoff point about the total score of nomogram was 72.5. The 3-month survival rate was significantly decreased when the total score of nomogram>72.5. Log-rank survival analysis showed a significant difference These results were supported by validation study.Conclusions: The ACHBLF nomograms could accurately predict the short-term survival for ACHBLF patients. |
