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Modified model for end-stage liver disease improves short-term prognosis of hepatitis B virus-related acute-on-chronic liver failure.
World J Gastroenterol. 2017 Oct 28; 23(40):7303-7309.WJ

Abstract

AIM

To investigate whether the short-term prognosis of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) could be improved by using a modified model for end-stage liver disease (MELD) including serum lactate.

METHODS

This clinical study was conducted at the First Affiliated Hospital, Fujian Medicine University, China. From 2009 to 2015, 236 patients diagnosed with HBV-related ACLF at our center were recruited for this 3-month follow-up study. Demographic data and serum lactate levels were collected from the patients. The MELD scores with or without serum lactate levels from survival and non-survival groups were recorded and compared.

RESULTS

Two hundred and thirty-six patients with HBV-ACLF were divided into two groups: survival group (S) and non-survival group (NS). Compared with the NS group, the patients in survival the S group had a significantly lower level of serum lactate (3.11 ± 1.98 vs 4.67 ± 2.43, t = 5.43, P < 0.001) and MELD score (23.33 ± 5.42 vs 30.37 ± 6.58, t = 9.01, P = 0.023). Furthermore, serum lactate level was positively correlated with MELD score (r = 0.315, P < 0.001). Therefore, a modified MELD including serum lactate was developed by logistic regression analysis (0.314 × lactate + 0.172 × MELD - 5.923). In predicting 3-month mortality using the MELD-LAC model, the patients from the S group had significantly lower baseline scores (-0.930 ± 1.34) when compared with those from the NS group (0.771 ± 1.32, t = 9.735, P < 0.001). The area under the receiver operating characteristic curve (AUROC) was 0.859 calculated by using the MELD-LAC model, which was significantly higher than that calculated by using the lactate level (0.790) or MELD alone (0.818). When the cutoff value was set at -0.4741, the sensitivity, specificity, positive predictive value and negative predictive value for predicting short-term mortality were 91.5%, 80.10%, 94.34% and 74.62%, respectively. When the MELD-LAC scores at baseline level were set at -0.5561 and 0.6879, the corresponding mortality rates within three months were 75% and 90%, respectively.

CONCLUSION

The short-term prognosis of HBV-related ACLF was improved by using a modified MELD including serum lactate from the present 6-year clinical study.

Authors+Show Affiliations

Center for Liver Diseases, the First Affiliated Hospital, Fujian Medicine University, Fuzhou 350005, Fujian Province, China.Center for Liver Diseases, the First Affiliated Hospital, Fujian Medicine University, Fuzhou 350005, Fujian Province, China.Center for Liver Diseases, the First Affiliated Hospital, Fujian Medicine University, Fuzhou 350005, Fujian Province, China.Center for Liver Diseases, the First Affiliated Hospital, Fujian Medicine University, Fuzhou 350005, Fujian Province, China.Center for Liver Diseases, the First Affiliated Hospital, Fujian Medicine University, Fuzhou 350005, Fujian Province, China.Center for Liver Diseases, the First Affiliated Hospital, Fujian Medicine University, Fuzhou 350005, Fujian Province, China. zhuyueyong@fjmu.edu.cn.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

29142477

Citation

Chen, Wei, et al. "Modified Model for End-stage Liver Disease Improves Short-term Prognosis of Hepatitis B Virus-related Acute-on-chronic Liver Failure." World Journal of Gastroenterology, vol. 23, no. 40, 2017, pp. 7303-7309.
Chen W, You J, Chen J, et al. Modified model for end-stage liver disease improves short-term prognosis of hepatitis B virus-related acute-on-chronic liver failure. World J Gastroenterol. 2017;23(40):7303-7309.
Chen, W., You, J., Chen, J., Zheng, Q., Jiang, J. J., & Zhu, Y. Y. (2017). Modified model for end-stage liver disease improves short-term prognosis of hepatitis B virus-related acute-on-chronic liver failure. World Journal of Gastroenterology, 23(40), 7303-7309. https://doi.org/10.3748/wjg.v23.i40.7303
Chen W, et al. Modified Model for End-stage Liver Disease Improves Short-term Prognosis of Hepatitis B Virus-related Acute-on-chronic Liver Failure. World J Gastroenterol. 2017 Oct 28;23(40):7303-7309. PubMed PMID: 29142477.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Modified model for end-stage liver disease improves short-term prognosis of hepatitis B virus-related acute-on-chronic liver failure. AU - Chen,Wei, AU - You,Jia, AU - Chen,Jing, AU - Zheng,Qi, AU - Jiang,Jia-Ji, AU - Zhu,Yue-Yong, PY - 2017/06/27/received PY - 2017/08/15/revised PY - 2017/09/05/accepted PY - 2017/11/17/entrez PY - 2017/11/17/pubmed PY - 2018/7/7/medline KW - Hepatitis B virus KW - Liver failure KW - Model for end-stage liver disease score KW - Prognosis KW - Serum lactate level SP - 7303 EP - 7309 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 23 IS - 40 N2 - AIM: To investigate whether the short-term prognosis of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) could be improved by using a modified model for end-stage liver disease (MELD) including serum lactate. METHODS: This clinical study was conducted at the First Affiliated Hospital, Fujian Medicine University, China. From 2009 to 2015, 236 patients diagnosed with HBV-related ACLF at our center were recruited for this 3-month follow-up study. Demographic data and serum lactate levels were collected from the patients. The MELD scores with or without serum lactate levels from survival and non-survival groups were recorded and compared. RESULTS: Two hundred and thirty-six patients with HBV-ACLF were divided into two groups: survival group (S) and non-survival group (NS). Compared with the NS group, the patients in survival the S group had a significantly lower level of serum lactate (3.11 ± 1.98 vs 4.67 ± 2.43, t = 5.43, P < 0.001) and MELD score (23.33 ± 5.42 vs 30.37 ± 6.58, t = 9.01, P = 0.023). Furthermore, serum lactate level was positively correlated with MELD score (r = 0.315, P < 0.001). Therefore, a modified MELD including serum lactate was developed by logistic regression analysis (0.314 × lactate + 0.172 × MELD - 5.923). In predicting 3-month mortality using the MELD-LAC model, the patients from the S group had significantly lower baseline scores (-0.930 ± 1.34) when compared with those from the NS group (0.771 ± 1.32, t = 9.735, P < 0.001). The area under the receiver operating characteristic curve (AUROC) was 0.859 calculated by using the MELD-LAC model, which was significantly higher than that calculated by using the lactate level (0.790) or MELD alone (0.818). When the cutoff value was set at -0.4741, the sensitivity, specificity, positive predictive value and negative predictive value for predicting short-term mortality were 91.5%, 80.10%, 94.34% and 74.62%, respectively. When the MELD-LAC scores at baseline level were set at -0.5561 and 0.6879, the corresponding mortality rates within three months were 75% and 90%, respectively. CONCLUSION: The short-term prognosis of HBV-related ACLF was improved by using a modified MELD including serum lactate from the present 6-year clinical study. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/29142477/Modified_model_for_end_stage_liver_disease_improves_short_term_prognosis_of_hepatitis_B_virus_related_acute_on_chronic_liver_failure_ L2 - http://www.wjgnet.com/1007-9327/full/v23/i40/7303.htm DB - PRIME DP - Unbound Medicine ER -