Scoring systems predict the prognosis of acute-on-chronic hepatitis B liver failure: an evidence-based review

Abstract

Acute-on-chronic hepatitis B liver failure is a devastating condition that is associated with mortality rates of over 50% and is consequent to acute exacerbation of chronic hepatitis B in patients with previously diagnosed or undiagnosed chronic liver disease. Liver transplantation is the definitive treatment to lower mortality rate, but there is a great imbalance between donation and potential recipients. An early and accurate prognostic system based on the integration of laboratory indicators, clinical events and some mathematic logistic equations is needed to optimize treatment for patients. As parts of the scoring systems, the MELD was the most common and the donor-MELD was the most innovative for patients on the waiting list for liver transplantation. This review aims to highlight the various features and prognostic capabilities of these scoring systems.

Keywords::

• acute-on-chronic hepatitis B liver failure
• artificial neural network
• Child-Turcotte-Pugh score
• donor-MELD
• King’s College Criteria
• liver transplantation
• model for end-stage liver disease
• prognosis
• regression scoring models
• scoring systems
• sequential organ failure assessment

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Acute-on-chronic hepatitis B liver failure (ACHBLF) is a devastating condition that is associated with a high mortality rate. Liver transplantation (LT) is the definitive treatment to lower mortality rate in patients with ACHBLF.

• An early and accurate prognostic system is needed to help guide and optimize treatment for patients with ACHBLF.

• The King’s College Criteria were simple and easy to manipulate; however, when applied to patients with ACHBLF, they had less utility than when applied to patients with acute liver failure.

• The Child–Turcotte–Pugh score was widely used for patients with portal hypertension. However, its efficacy was limited by the experience and subjective variables.

• The model for end-stage liver disease (MELD) with objective and quantitative variables was the most common scoring system to evaluate patients on the waiting list for LT.

• The logistic regression scoring models including clinical events and biochemical values resulted in a great prognostic value. However, there was a lack of consistent variables.

• The artificial neural network was the most accurate system to predict patient mortality. However, it was too complicated to use at the bedside.

• With the limitation of patients admitted to the intensive care unit, sequential organ failure assessment was not widely used in the field of ACHBLF in most Asia-Pacific countries.

• Donor-MELD score is an innovative product of donor age and preoperative MELD with a simple and highly predictive value for patients on waiting list for LT.

• Cox regression analysis models and multicenter prospective studies with clinical and statistical validation of larger populations are needed to improve the efficacy.