A simple scoring system for evaluating severity of HBV-related acute-on-chronic liver failure

Objective To establish a simple scoring system for evaluating the severity of hepatitis B virus ( HBV) -related acute-on-chronic liver failure ( HBV-ACLF) . Methods A retrospective analysis was performed on the clinical data of 620 patients with HBV-ACLF who were divided into group I ( 500 patients) and group II ( 120 patients) . Seven clinical parameters, including hepatic encephalopathy, serum creatinine, prothrombin activity, serum total bilirubin, infection, dimension of liver, and maximum depth of ascites, were scored from 0-4 points for each patient according to the disease severity. The severity scoring system was established based on the total score of each patient in group I, with the cut-off point being determined. The established system was tested with group II. Results A severity scoring system was successfully developed based on chi-squared automatic interaction detector analysis of the total score of each patient in group I. There was a significant difference in the total score between the survival and death subgroups of the 500 patients ( t = 25. 78, P <0. 001) . The area under the ROC curve was 0. 963, suggesting a high validity of this scoring system. With the cut-off value of 9. 5, the sensitivity and specificity of this system were 0. 98 and 0. 83, respectively. The other 120 patients were divided into the poor prognosis ( score ≥10) and good prognosis subgroups ( score ≤9) based on the scoring system, with the mortality rates being 84.3% and 3.5%, respectively; there was a significant difference in mortality between the two subgroups ( χ2= 72. 2, P < 0. 001) . Conclusion This scoring system is simple, sensitive, and objective to evaluate the severity of HBV-ACLF.