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Abstract：
BACKGROUND: Type C hepatitis B-related acute-on-chronic liver failure (HBV-ACLF), which is based on decompensated cirrhosis, has different laboratory tests, precipitating events, organ failure and clinical outcomes. The predictors of prognosis for type C HBV-ACLF patients are different from those for other subgroups. This study aimed to construct a novel, short-term prognostic score that applied serological indicators of hepatic regeneration and noninvasive assessment of liver fibrosis to predict outcomes in patients with type C HBV-ACLF.
METHODS: Patients with type C HBV-ACLF were observed for 90 days. Demographic information, clinical examination, and laboratory test results of the enrolled patients were collected. Univariate and multivariate logistic regression were performed to identify independent prognostic factors and develop a novel prognostic scoring system. A receiver operating characteristic (ROC) curve was used to analyse the performance of the model.
RESULTS: A total of 224 patients with type C HBV-ACLF were finally included. The overall survival rate within 90 days was 47.77%. Age, total bilirubin (TBil), international normalized ratio (INR), alpha-fetoprotein (AFP), white blood cell (WBC), serum sodium (Na), and aspartate aminotransferase/platelet ratio index (APRI) were found to be independent prognostic factors. According to the results of the logistic regression analysis, a new prognostic model (named the A3Twin score) was established. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) was 0.851 [95% CI (0.801-0.901)], the sensitivity was 78.8%, and the specificity was 71.8%, which were significantly higher than those of the MELD, IMELD, MELD-Na, TACIA and COSSH-ACLF II scores (all P < 0.001). Patients with lower A3Twin scores (<-9.07) survived longer.
CONCLUSIONS: A new prognostic scoring system for patients with type C HBV-ACLF based on seven routine indices was established in our study and can accurately predict short-term mortality and might be used to guide clinical management.
METHODS: Patients with type C HBV-ACLF were observed for 90 days. Demographic information, clinical examination, and laboratory test results of the enrolled patients were collected. Univariate and multivariate logistic regression were performed to identify independent prognostic factors and develop a novel prognostic scoring system. A receiver operating characteristic (ROC) curve was used to analyse the performance of the model.
RESULTS: A total of 224 patients with type C HBV-ACLF were finally included. The overall survival rate within 90 days was 47.77%. Age, total bilirubin (TBil), international normalized ratio (INR), alpha-fetoprotein (AFP), white blood cell (WBC), serum sodium (Na), and aspartate aminotransferase/platelet ratio index (APRI) were found to be independent prognostic factors. According to the results of the logistic regression analysis, a new prognostic model (named the A3Twin score) was established. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) was 0.851 [95% CI (0.801-0.901)], the sensitivity was 78.8%, and the specificity was 71.8%, which were significantly higher than those of the MELD, IMELD, MELD-Na, TACIA and COSSH-ACLF II scores (all P < 0.001). Patients with lower A3Twin scores (<-9.07) survived longer.
CONCLUSIONS: A new prognostic scoring system for patients with type C HBV-ACLF based on seven routine indices was established in our study and can accurately predict short-term mortality and might be used to guide clinical management.
摘要：
背景：丙型肝炎相关的慢性急性肝衰竭（HBV-ACLF），这是基于失代偿性肝硬化，有不同的实验室测试，沉淀事件，器官衰竭和临床结果。C型HBV-ACLF患者的预后预测因子与其他亚组不同。本研究旨在构建一部小说,短期预后评分应用肝再生血清学指标和肝纤维化无创评估来预测C型HBV-ACLF患者的预后。
方法：C型HBV-ACLF患者观察90天。人口统计信息,临床检查,并收集入选患者的实验室检查结果.进行单变量和多变量逻辑回归以确定独立的预后因素并开发新的预后评分系统。接收器工作特性（ROC）曲线用于分析模型的性能。
结果：最终纳入224例C型HBV-ACLF患者。90天内总生存率为47.77%。年龄,总胆红素（TBil），国际标准化比率(INR)，甲胎蛋白（AFP），白细胞（WBC），血清钠（Na），天门冬氨酸转氨酶/血小板比值指数(APRI)是影响预后的独立因素。根据logistic回归分析的结果,建立了一个新的预后模型（称为A3Twin评分）。受试者工作特征曲线（ROC）的曲线下面积（AUC）为0.851[95％CI（0.801-0.901）]，灵敏度为78.8%,特异性为71.8%，明显高于MELD，IMELD,MELD-Na,TACIA和COSSH-ACLFII评分(均P<0.001)。A3Twin评分较低（<-9.07）的患者存活时间更长。
结论：本研究建立了以7项常规指标为基础的C型HBV-ACLF患者预后评分系统，能够准确预测近期病死率，可用于指导临床治疗。
方法：C型HBV-ACLF患者观察90天。人口统计信息,临床检查,并收集入选患者的实验室检查结果.进行单变量和多变量逻辑回归以确定独立的预后因素并开发新的预后评分系统。接收器工作特性（ROC）曲线用于分析模型的性能。
结果：最终纳入224例C型HBV-ACLF患者。90天内总生存率为47.77%。年龄,总胆红素（TBil），国际标准化比率(INR)，甲胎蛋白（AFP），白细胞（WBC），血清钠（Na），天门冬氨酸转氨酶/血小板比值指数(APRI)是影响预后的独立因素。根据logistic回归分析的结果,建立了一个新的预后模型（称为A3Twin评分）。受试者工作特征曲线（ROC）的曲线下面积（AUC）为0.851[95％CI（0.801-0.901）]，灵敏度为78.8%,特异性为71.8%，明显高于MELD，IMELD,MELD-Na,TACIA和COSSH-ACLFII评分(均P<0.001)。A3Twin评分较低（<-9.07）的患者存活时间更长。
结论：本研究建立了以7项常规指标为基础的C型HBV-ACLF患者预后评分系统，能够准确预测近期病死率，可用于指导临床治疗。
