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20 July 2022 : Original article  

[In Press] Development of a Novel Model for Predicting Postoperative Short-Term Outcome in Patients with Hepatitis B-Related Acute-on-Chronic Liver Failure Undergoing Liver Transplantation

Qikun Zhang12ABCDEF, Menglong Wang2ADF, Guangming Li2BDG, Zhongtao Zhang1ADE

DOI: 10.12659/AOT.936732

Ann Transplant In Press; DOI: 10.12659/AOT.936732  

Available online: 2022-07-20, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
We aimed to create a novel predictive model through comparing the prognostic accuracy of the current mainstream scoring models in predicting the short-term outcome of patients with hepatitis B-related acute-on-chronic liver failure (HBACLF) undergoing liver transplantation (LT).
MATERIAL AND METHODS
Data on patients with HBACLF undergoing LT were retrospectively collected and analyzed. The area under the time-dependent receiver operating characteristic curve of 16 scoring models was calculated to evaluate their performance in predicting short-term survival after LT. Univariate analyses and LASSO regression were used to identify the independent variables, which were further selected by Cox stepwise regression.
RESULTS
A total of 135 patients were enrolled. Among the 16 scoring models, MELD-Na performed the best in predicting 3-month mortality after LT, with an AUC of 0.716. LASSO regression analysis revealed that only the MELD-Na was confirmed as an independent predictor (HR 1.0481, 95% C.I [1.0136, 1.0838], P<0.05). Cox stepwise regression identified 4 variables – MELD-Na, sex, systemic infection, and placement of T-tube during operation – which were used to construct a novel prognostic model with a C-index of 0.844 and a Brier score of 0.131 after internal validation and a C-index of 0.824 (95% C.I [0.658, 0.989]) and a Brier score of 0.119 in the external validation cohort at 3 months.
CONCLUSIONS
Compared with other scoring models, MELD-Na was an independent factor in predicting short-term outcome after LT. The constructed novel predictive model could exert clinical benefits on early prognostic assessment and case selection.

Keywords: Acute-On-Chronic Liver Failure; Liver Transplantation; Patient Outcome Assessment; Predictive Value of Tests

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358