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Establishment and validation of a prognostic model for hepatitis B virus‑related acute-on-chronic liver failure patients with bacterial infection

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Abstract

Background

Bacterial infection is one of the most frequent complications in acute-on-chronic liver failure (ACLF), which leads to high mortality. However, a specific prognostic model for ACLF patients with bacterial infection has not been well established.

Aim

To establish and validate a nomogram for predicting 30-day mortality of hepatitis B virus-related ACLF (HBV-ACLF) patients with bacterial infection.

Methods

A total of 513 ACLF patients for HBV reactivation were enrolled in the prospective cohort, and 224 patients with bacterial infection were for derivation. Independent predictors were identified using multivariate logistic model and then assembled into a nomogram to predict 30-day mortality. The performance of the nomogram was assessed based on its calibration, discrimination and clinical utility in a retrospective cohort of 192 HBV-ACLF patients with bacterial infection.

Results

Age, total bilirubin, lactate dehydrogenase, international normalized ratio and soluble interleukin-2 receptor were shown to be independent risk factors for 30-day mortality of HBV-ACLF patients with bacterial infection and the nomogram was constructed. The nomogram showed a good calibration and discrimination in the derivation cohort, with an area under the receiver operating characteristic curve (AUC) of 0.883. Application of the nomogram in the validation cohort also showed a good calibration and discrimination, with the AUC of 0.852. Decision curve analysis confirmed the clinical utility of the nomogram.

Conclusion

The nomogram was established and validated for predicting 30-day mortality of HBV-ACLF patients with bacterial infection, which may facilitate optimal therapeutic strategies to improve the prognosis of these patients.

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Availability of data

We declared that data described in the manuscript would be freely available to any scientist wishing to use them for non-commercial purposes.

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Funding

This study was funded by the National Thirteenth “Five Years” Project in Science and Technology of China (2017ZX10202201, 2018ZX10302-206).

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Authors and Affiliations

  1. Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, Hubei, People’s Republic of China

    Zhongwei Zhang, Zhongyuan Yang, Qiuyu Cheng, Xue Hu, Meiqi Liu, Yunhui Liu, Tingting Liu, Ke Ma, Meng Zhang, Tao Chen & Qin Ning

  2. Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, Hubei, People’s Republic of China

    Xiaoping Luo

Authors
  1. Zhongwei Zhang
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  2. Zhongyuan Yang
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  3. Qiuyu Cheng
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  4. Xue Hu
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  5. Meiqi Liu
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  6. Yunhui Liu
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  7. Tingting Liu
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  8. Ke Ma
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  9. Meng Zhang
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  10. Xiaoping Luo
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  11. Tao Chen
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  12. Qin Ning
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Contributions

All authors were involved in the critical revision of the manuscript. TC and QN contributed to the study conception and design. ZZ, ZY, QC, XH, ML, YL, KM, TL, MZ enrolled patients and collected clinical data. ZZ analyzed clinical data and drafted the manuscript. XL had contributions to the revision of the manuscript in discussion, data re-evaluation and presentation, and manuscript edition. All authors approved the final version of the manuscript, including the authorship list.

Corresponding authors

Correspondence to Tao Chen or Qin Ning.

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Conflict of interest

All authors declare no conflicts of interest about this work.

Ethical approval

Data of all patients were acquired from the electronic medical records system and analyzed anonymously according to the Declaration of Helsinki of 1975, as revised in 2008. A written informed consent of patient was acquired based on registered clinical trial (NCT03362632) in the prospective derivation cohort. However, the patient informed consent was waived in the retrospective validation cohort according to approved protocol by the Ethics Committee of Tongji Hospital.

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All authors read and approved the manuscript.

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Cite this article

Zhang, Z., Yang, Z., Cheng, Q. et al. Establishment and validation of a prognostic model for hepatitis B virus‑related acute-on-chronic liver failure patients with bacterial infection. Hepatol Int 16, 38–47 (2022). https://doi.org/10.1007/s12072-021-10268-6

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  • DOI: https://doi.org/10.1007/s12072-021-10268-6

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