Development and validation of a dynamic prognostic score for hepatitis B virus-related acute-on-chronic liver failure

Aims Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is a rapidly progressive syndrome with high mortality. This study aimed to develop a dynamic prognostic score for precise outcome prediction in HBV-ACLF patients. Methods Data from a single-center prospective cohort were used to develop the dynamic prognostic score. The dynamic prognostic score was validated in an external multiple-center prospective cohort. Results A total of 124 patients with HBV-ACLF were enrolled in the derivation group. Chinese Severe Hepatitis B Research Group-ACLF II (COSSH-ACLF II) score outperformed CLIF Consortium acute-on-chronic liver failure (CLIF-C ACLF) score and Model for End-Stage Liver Disease (MELD) score in predicting 28/90-day mortality. The difference in COSSH-ACLF II score between day 7 and baseline (δCOSSH-ACLF II 7 − 0) had better performance than the baseline COSSH-ACLF II score. The multivariate COX regression found baseline total bilirubin (TB), baseline prothrombin time international normalized ratio (PT-INR) and δCOSSH-ACLF II 7 − 0 as independent predictors for 90-day survival. We proposed a dynamic prognostic score = 0.005 × TB + 0.609 × PT-INR + 1.234 × δCOSSH ACLF Ⅱ7 − 0. The AUC of the new score was 0.923 and 0.925 for 28- and 90-days mortality, surpassing the other three models. Calibration and decision curve analyses confirmed clinical utility, and a nomogram was developed for visualization. These findings were replicated in the external validation cohort. Conclusion A new prognostic score based on the dynamic clinical course can accurately predict short-term mortality in patients with HBV-ACLF.