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Development and validation of a prognostic nomogram for acute‐on‐chronic hepatitis B liver failure
Author(s) -
Shi KeQing,
Cai YiJing,
Lin Zhuo,
Dong JinZhong,
Wu JianMin,
Wang XiaoDong,
Song Mei,
Wang YuQun,
Chen YongPing
Publication year - 2017
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.13502
Subject(s) - medicine , nomogram , liver failure , chronic hepatitis , gastroenterology , intensive care medicine , immunology , virus
Background and Aim Determining individual risk of short‐term mortality in patients with acute‐on‐chronic hepatitis B liver failure (ACHBLF) is a difficult task. We aimed to develop and externally validate a prognostic nomogram for ACHBLF patients. Methods The nomogram was built to estimate the probability of 30‐day, 60‐day, 90‐day, and 60‐month survival based on an internal cohort of 246 patients with ACHBLF. The predictive accuracy and discriminative ability of nomogram were determined by a concordance index (C‐index), calibration curve, and time‐dependent receiver operating characteristics (tdROC), comparing with model for end‐stage liver disease (MELD) score. The results were validated using bootstrap resampling and an external cohort of 138 patients. Furthermore, we plotted decision curves to evaluate the clinical usefulness of nomogram. Results Independent factors derived from multivariable Cox analysis of training cohort to predict mortality were age, total bilirubin, serum sodium, and prothrombin activity, which were all assembled into nomogram. The calibration curves for probability of survival showed optimal agreement between nomogram prediction and actual observation. The C‐index of nomogram was higher than that of MELD score for predicting survival (30‐day, 0.809 vs 0.717, P < 0.001; 60‐day, 0.792 vs 0.685, P < 0.001; 90‐day, 0.779 vs 0.678, P < 0.001; 6‐month, 0.781 vs 0.677, P < 0.001). Additionally, tdROC and decision curves also showed that nomogram was superior to MELD score. The results were confirmed in validation cohort. Conclusions The prognostic nomogram provided an individualized risk estimate of short‐term survival in patients with ACHBLF, offering to clinicians to improve their abilities to assess patient prognosis.