Value of MELD、AARC、COSSH ccoring systems in evaluating the 90-day prognosis of hepatitis B virus-related acute-on-chronic liver failure

Objective To investigate the value of Model for End-Stage Liver Disease( MELD),APASL-ACLF Research Consortium( AARC),and Chinese Group on the Study of Severe Hepatitis B( COSSH) scoring systems in evaluating the 90-day prognosis of hepatitis B virus-related acute-on-chronic liver failure( HBV-ACLF). Methods A retrospective analysis was performed for the clinical data of88 patients with HBV-ACLF who were hospitalized in Chaoyang Central Hospital from July 2017 to May 2019,and according to the follow-up results on day 90 after admission,the patients were divided into survival group with 35 patients and death group with 53 patients. The influencing factors for the 90-day prognosis of HBV-ACLF patients were analyzed; the above three scores were determined,and their predictive value was evaluated. The t-test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups; the chi-square test was used for comparison of categorical data between groups. A multivariate binary logistic regression analysis was used to investigate the influencing factors for the prognosis of HBV-ACLF. The receiver operating characteristic( ROC) curve was plotted,and the Z test was used for comparison of area under the ROC curve( AUC) between two scores. Results The univariate analysis showed that there were significant differences between the two groups in age,total bilirubin( TBil),white blood cell count,platelet count,uric acid,creatinine( Cr),prothrombin activity,serum sodium concentration( Na),international standardized ratio,arterial blood lactate,oxygenation index( PaO2/FiO2),complications( hepatic encephalopathy,pulmonary infection,upper gastrointestinal bleeding,and hepatorenal syndrome),MELD score,AARC score,and COSSH score( all P < 0. 05). The multivariate logistic regression analysis found that TBil( odds ratio [OR]= 0. 982,95%confidence interval [CI]: 0. 970-0. 995,P = 0. 006),Na( OR = 1. 168,95% CI: 1. 024-1. 332,P = 0. 021),Cr( OR = 0. 950,95%CI: 0. 906-0. 996,P = 0. 033),age( OR = 0. 910,95% CI: 0. 842-0. 983,P = 0. 016),and PaO2/FiO2( OR = 1. 058,95% CI: 1. 028-1. 089,P < 0. 001) were independent influencing factors for the 90-day prognosis of patients with HBV-ACLF. The ROC curve analysis showed that COSSH score had significantly higher AUC and Youden index than MELD score( 0. 937/0. 820 vs 0. 836/0. 574) and AARC score( 0. 937/0. 820 vs 0. 816/0. 497),and COSSH score had a significantly higher AUC than AARC score( Z = 3. 082,P < 0. 05).Conclusion These three scoring systems have a good value in evaluating the 90-day prognosis of HBV-ACLF patients,and COSSH score may have a higher value than the other two scores.