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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 27, 2026; 18(2): 113552
Published online Feb 27, 2026. doi: 10.4254/wjh.v18.i2.113552
Published online Feb 27, 2026. doi: 10.4254/wjh.v18.i2.113552
Dynamic inflammation-based prognostication in acute-on-chronic liver failure: The COSSH-CAR model as a step forward in personalized risk stratification
Noura A A Ebrahim, Department of Oncologic Pathology, National Cancer Institute, Cairo University, Cairo 11796, Al Qāhirah, Egypt
Thoraya A Farghaly, Department of Chemistry, Faculty of Science, Umm Al-Qura University, Makkah 21955, Saudi Arabia
Soliman M A Soliman, Department of Chemistry, Faculty of Science, Cairo University, Cairo 12613, Al Qāhirah, Egypt
Co-corresponding authors: Noura A A Ebrahim and Soliman M A Soliman.
Author contributions: Ebrahim NAA and Soliman SMA participated in shaping the editorial’s concept, drafting the content, and revising the manuscript; Farghaly TA offered additional guidance and contributed to the final editorial polishing; All authors reviewed and approved the completed manuscript. Ebrahim NAA and Soliman SMA contributed equally to this manuscript and are co-corresponding authors
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Noura A A Ebrahim, MD, PhD, Department of Oncologic Pathology, National Cancer Institute, Cairo University, Kasr Al Eini Street, Fom El Khalig, Cairo 11796, Al Qāhirah, Egypt. npathologist@gmail.com
Received: August 28, 2025
Revised: October 18, 2025
Accepted: December 8, 2025
Published online: February 27, 2026
Processing time: 168 Days and 13.6 Hours
Revised: October 18, 2025
Accepted: December 8, 2025
Published online: February 27, 2026
Processing time: 168 Days and 13.6 Hours
Core Tip
Core Tip: The dynamic shift in the C-reactive protein to albumin ratio (CAR) during the initial week provides additional prognostic insight into Chinese Group on Study of Severe Hepatitis B-defined acute-on-chronic liver failure, surpassing the predictive capacity of traditional indices such as the model for end-stage liver disease sodium score and hepatic encephalopathy grade. Embedding 7-day variation of CAR within the Chinese Group on Study of Severe Hepatitis B-CAR score yields a biologically plausible, practical bedside instrument. Nonetheless, confirmation through robust, multicenter validation is essential before widespread clinical application can be recommended.