CHINAT-CD4 Score Predicts Transplant-Free Survival in Patients with Acute-on-Chronic Liver Failure

Abstract

Aim

The early prognosis evaluation of acute-on-chronic liver failure (ACLF) is important to decrease its mortality. We aimed to develop a new score to accurately predict the outcome of patients with ACLF.

Methods

A derivation set of 408 patients with hepatitis B virus-related ACLF (HBV-ACLF) based on the Asian Pacific Association for the Study of the Liver criteria is used to develop a prognostic score that was validated in 209 patients with HBV-ACLF and 195 patients with non-HBV-ACLF.

Results

Seven factors were significantly related to the 28-day mortality and constituted a new score (CHINAT-CD4 = 0.320 × ln (creatinine) + 0.668 × hepatic encephalopathy score + 0.745 × ln (international normalized ratio) + 0.476 × ln (neutrophil) + 0.251 × ln (aspartate aminotransferase) + 0.411 × ln (total bilirubin) - 0.605 × ln (CD4+ T cells count)). The C-indices of the new score for the 28-/90-day mortality (0.810/0.806) outperformed those of the other seven scores (p≤0.05). The results were confirmed in a validation set (0.798/793 for HBV-ACLF; 0.790/0.788 for non-HBV-ACLF). The novel score based on CD4⁺ T cell count showed high predictive performance for the 28-/90-day mortality of ACLF.

Conclusion

The novel score based on CD4⁺ T cell count can accurately predict the 28-/90-day mortality for patients with ACLF.

Keywords:

• liver failure
• chronic liver disease
• prognostic score
• risk stratification
• inflammatory markers

Abbreviations

ACLF, acute-on-chronic liver failure; HCV, hepatitis C virus; CLIF-C, Chronic Liver Failure Consortium; COSSH, Chinese Group on the Study of Severe Hepatitis B; HBV-ACLF, hepatitis B virus-related ACLF; Cr, creatinine; HE, hepatic encephalopathy; INR, international normalized ratio; AST, aspartate aminotransferase; TB, total bilirubin; MELD, model for end-stage liver disease; MELD-Na, MELD-sodium; PH, proportional hazard; HR, hazard ratio; VIF, variance inflation factor; SD, standard deviation; IQR, interquartile range; ALT, alanine aminotransferase; WBC, white blood cell count.

Ethical Statement

The study protocol was approved by the clinical research ethics committee of the Shanghai Public Health Clinical Center. All patients signed the informed consents. The procedures were performed in accordance with the ethical standards of the Helsinki Declaration (1964, amended most recently in 2008) of the World Medical Association. Written informed consents were obtained from all patients.

Consent for Publication

All authors read and approved the manuscript.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was supported by the ShenKang development center of Shanghai (SHDC12020109), the science and technology commission of Shanghai (21S11905600) and the Shanghai Municipal Health Commission(2022YQ027). The funding organizations are public institutions and had no role in the design and conduct of the study; collection, management, and analysis of the data; or preparation, review, and approval of the manuscript.