Journal
JOURNAL OF CLINICAL AND TRANSLATIONAL HEPATOLOGY
Volume 9, Issue 6, Pages 838-849Publisher
XIA & HE PUBLISHING INC
DOI: 10.14218/JCTH.2021.00005
Keywords
Hepatitis B virus; Acute-on-chronic liver failure; Clinical prediction models; Quality and performance
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Funding
- Chinese National Natural Science Foundation [81670567, 81870425]
- Fundamental Research Funds for the Central Universities
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This study systematically summarized and evaluated 52 clinical prediction models for predicting the prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). The study found substantial limitations in the quality of HBV-ACLF-specific CPMs, and suggested that disease severity of study populations may impact model performance.
Background and Aims: It is critical but challenging to predict the prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). This study systematically summarized and evaluated the quality and performance of available clinical prediction models (CPMs). Methods: A keyword search of articles on HBV-ACLF CPMs published in PubMed from January 1995 to April 2020 was performed. Both the quality and performance of the CPMs were assessed. Results: Fifty-two CPMs were identified, of which 31 were HBV-ACLF specific. The modeling data were mostly derived from retrospective (83.87%) and single-center (96.77%) cohorts, with sample sizes ranging from 46 to 1,202. Three-month mortality was the most common endpoint. The Asian Pacific Association for the Study of the Liver consensus (51.92%) and Chinese Medical Association liver failure guidelines (40.38%) were commonly used for HBV-ACLF diagnosis. Serum bilirubin (67.74%), the international normalized ratio (54.84%), and hepatic encephalopathy (51.61%) were the most frequent variables used in models. Model discrimination was commonly evaluated (88.46%), but model calibration was seldom performed. The model for end-stage liver disease score was the most widely used (84.62%); however, varying performance was reported among the studies. Conclusions: Substantial limitations lie in the quality of HBV-ACLF-specific CPMs. Disease severity of study populations may impact model performance. The clinical utility of CPMs in predicting short-term prognosis of HBV-ACLF remains to be undefined.
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