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A Model to Predict 1‐Month Risk of Transplant or Death in Hepatitis A–Related Acute Liver Failure
Author(s) -
Kim Jin Dong,
Cho Eun Ju,
Ahn Choonghyun,
Park Sue K.,
Choi Jong Young,
Lee Han Chu,
Kim Do Young,
Choi Moon Seok,
Wang Hee Jung,
Kim In Hee,
Yeon Jong Eun,
Seo Yeon Seok,
Tak Won Young,
Kim Moon Young,
Lee Heon Ju,
Kim Yun Soo,
Jun Dae Won,
Sohn Joo Hyun,
Kwon So Young,
Park Sang Hoon,
Heo Jeong,
Jeong SookHyang,
Lee JeongHoon,
Nakayama Nobuaki,
Mochida Satoshi,
Ido Akio,
Tsubouchi Hirohito,
Takikawa Hazime,
Acharya Subrat Kumar,
Bernal William,
O’Grady John,
Kim Yoon Jun
Publication year - 2019
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.30262
Subject(s) - medicine , hazard ratio , liver disease , confidence interval , gastroenterology , creatinine , hepatitis c , hepatitis , model for end stage liver disease , statistic , bilirubin , liver transplantation , transplantation , statistics , mathematics
Acute liver failure (ALF) caused by hepatitis A is a rare but fatal disease. Here, we developed a model to predict outcome in patients with ALF caused by hepatitis A. The derivation set consisted of 294 patients diagnosed with hepatitis A–related ALF (ALFA) from Korea, and a validation set of 56 patients from Japan, India, and United Kingdom. Using a multivariate proportional hazard model, a risk‐prediction model (ALFA score) consisting of age, international normalized ratio, bilirubin, ammonia, creatinine, and hemoglobin levels acquired on the day of ALF diagnosis was developed. The ALFA score showed the highest discrimination in the prediction of liver transplant or death at 1 month (c‐statistic, 0.87; 95% confidence interval [CI], 0.84‐0.92) versus King’s College criteria (KCC; c‐statistic, 0.56; 95% CI, 0.53‐0.59), U.S. Acute Liver Failure Study Group index specific for hepatitis A virus (HAV‐ALFSG; c‐statistic, 0.70; 95% CI, 0.65‐0.76), the new ALFSG index (c‐statistic, 0.79; 95% CI, 0.74‐0.84), Model for End‐Stage Liver Disease (MELD; c‐statistic, 0.79; 95% CI, 0.74‐0.84), and MELD including sodium (MELD‐Na; c‐statistic, 0.78; 95% CI, 0.73‐0.84) in the derivation set (all P < 0.01). In the validation set, the performance of the ALFA score (c‐statistic, 0.84; 95% CI, 0.74‐0.94) was significantly better than that of KCC (c‐statistic, 0.65; 95% CI, 0.52‐0.79), MELD (c‐statistic, 0.74; 95% CI, 0.61‐0.87), and MELD‐Na (c‐statistic, 0.72; 95% CI, 0.58‐0.85) (all P < 0.05), and better, but not statistically significant, than that of the HAV‐ALFSG (c‐statistic, 0.76; 95% CI, 0.61‐0.90; P = 0.28) and new ALFSG indices (c‐statistic, 0.79; 95% CI, 0.65‐0.93; P = 0.41). The model was well‐calibrated in both sets. Conclusion: Our disease‐specific score provides refined prediction of outcome in patients with ALF caused by hepatitis A.