Value of the COSSH-ACLFs model in predicting the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure

Objective To investigate the value of the COSSH-ACLFs model in predicting the short-term( 90-day) prognosis of patient with hepatitis B virus-related acute-on-chronic liver failure( HBV-ACLF). Methods A total of 573 patients who were diagnosed with HBV-ACLF in The Affiliated Hospital of Southwest Medical University,The First People's Hospital of Neijiang,and The Second People's Hospital of Yibin were enrolled,and their general information and laboratory markers were collected. According to the outcome on day90 after diagnosis,the patients were divided into survival group with 339 patients and death group with 234 patients. The t-test was used for comparison of normally distributed continuous data between two groups,and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups,and the Wilcoxon rank sum test was used for comparison of ranked data between two groups. The area under the receiver operating characteristic curve( AUC) was used to compare the value of different models in predicting 90-day prognosis. Results Compared with the survival group,the death group had significantly higher age( Z =-0. 304,P = 0. 002),bilirubin( Z =-5. 961,P < 0. 001),peripheral white blood cell count( Z =-6. 027,P < 0. 001),and creatinine( Z =-4. 638,P < 0. 001),significantly lower hemoglobin( Z =-2. 012,P = 0. 044),albumin( Z =-4. 007,P < 0. 001),and Na( Z =-4. 558,P < 0. 001),and significantly higher incidence rates of hepatic encephalopathy( Z =-7. 859,P < 0. 001),peritonitis( Z =-2. 310,P = 0. 021),and upper gastrointestinal bleeding( χ2= 11. 697,P =0. 001). Compared with the death group,the survival group had significantly better coagulation markers,prothrombin time,international normalized ratio,and prothrombin time activity( Z =-7. 737,-7. 672,and-7. 867,all P < 0. 001). MELD,MELD-Na,CLIF-COFs,CLIF-CACLFs,and COSSH-ACLFs had an area under the ROC curve( AUC) of 0. 726,0. 587,0. 712,0. 735,and 0. 750,respectively,and the COSSH-ACLFs model had a significantly larger AUC than the other four models( Z = 7. 89,18. 83,12. 49,and 5. 05,all P < 0. 001). Conclusion The COSSH-ACLFs model has a better value than CLIF-C ACLFs,MELD,CLIF-C OFs,and MELD-Na in predicting the short-term prognosis of patients with HBV-ACLF.