Modified model for end-stage liver disease improves short-term prognosis of hepatitis B virus-related acute-on-chronic liver failure

Table 1 Demographic data, biochemical factors, clinical and surgical characteristics for the S and NS groups

Group	S (n = 130)	NS (n = 106)	t or t’	P value
Age (yr)	43.51 ± 14.13	45.97 ± 10.69	1.480	0.140
Male/Female (n)	110/20	87/19	0.273	0.363
Liver cirrhosis, n (%)	63 (48.46)	68 (64.15)	5.820	0.011
TBil (µmol/L)	344.85 ± 160.82	456.63 ± 180.43	5.040	< 0.001
ALT	92.62 ± 82.80	101.84 ± 83.71	0.847	0.389
AST	92.81 ± 91.84	103.86 ± 79.20	0.978	0.329
GLO	27.72 ± 8.95	27.84 ± 8.85	0.100	0.920
WBC	8.27 ± 4.12	8.21 ± 4.29	-0.117	0.907
PCT	0.53 ± 0.29	0.58 ± 0.54	0.886	0.377
Ammonia	67.29 ± 35.55	69.03 ± 47.57	-0.312	0.755
INR	2.46 ± 0.97	3.11 ± 1.63	3.733	< 0.001
Cr (µmol/L)	79.31 ± 45.25	99.80 ± 88.74	2.293	< 0.001
CHE (U/L)	3956.30 ± 1377.54	3529.00 ± 1509.89	0.170	0.859
Alb (g/L)	31.22 ± 3.98	30.99 ± 3.96	-0.428	0.398
DNA	594275 ± 230160	425886 ± 110810	-0.691	0.491
LAC (mmol/L)	3.11 ± 1.98	4.67 ± 2.43	5.430	< 0.001
< 2.68	76	14	50.685	0
2.68-4	37	29	0.035	0.484
≥ 4	17	63	55.999	< 0.001
CTP	10.54 ± 1.63	10.74 ± 1.73	0.892	0.373
MELD score	23.33 ± 5.42	30.37 ± 6.58	9.010	0.023
Plasmapheresis	68	57	0.05	0.896

TBil: Total bilirubin; Cr: Creatinine; INR: International normalized ratio for prothrombin time; MELD: Model for end-stage liver disease; LAC: The venous lactate; ALB: Albumin; GLO: Globulin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CHE: Cholinesterase; WBC: White blood cell; PCT: Procalcitonin; CTP: Child-Turcotte-Pugh score.

Table 2 Factors correlated with prognosis of hepatitis B virus-related acute-on-chronic liver failure

Factor	Correlation index	P value
MELD	0.548	< 0.001
LAC	0.499	< 0.001
TBiL	0.308	< 0.001
INR	0.289	< 0.001
Cr	0.014	0.828
Alb	0.071	0.273
CHE	0.058	0.373

TBil: Total bilirubin; Cr: Creatinine; INR: International normalized ratio for prothrombin time; MELD: Model for end-stage liver disease; LAC: The venous lactate; ALB: Albumin; CHE: Cholinesterase.

Table 3 The regression coefficients and indices of the model for end-stage liver disease and the venous lactate model

Index	β	SE	Wald	df	P value	Exp(β)
MELD	0.172	0.028	37.198	1	0.000	1.188
LAC	0.314	0.098	10.195	1	0.001	1.368
Constant	-5.923	0.824	51.724	1	0.000	0.003

MELD: Model for end-stage liver disease; LAC: The venous lactate.

Table 4 Prognostic value of the various models

model	AUROC	95%CI	Cut-offvalue	Sensitivity	Specificity	PPV	NPV
MELD	0.818	0.759-0.877	24.5	87.70 %	63.80%	85.85%	64.62%
LAC	0.79	0.730-0.850	2.68	86.80%	62.10%	86.79%	58.46%
MELD-LAC	0.859	0.807-0.911	-0.4741	91.50%	80.10%	94.34%	74.62%

AUROC: The area under the receiver operating characteristic; PPV: Positive predictive value; NPV: Negative predictive value. LAC: The venous lactate; MELD: Model for end-stage liver disease.

Table 5 Comparison of prediction performance of the model for end-stage liver disease and the modified model

Groups		Non-survival	Survival	χ2, P value
MELD	MELD < 25	16	83	56.98, < 0.001
	MELD≥ 25	90	47
MELD-LAC	MELD-LAC < -0.4741	13	100	107.35, < 0.001
	MELD-LAC ≥ -0.4741	97	26

MELD: Model for end-stage liver disease; LAC: The venous lactate.