A Criteria and Identification of Hepatitis B Virus-Related Pre-Acute-On-Chronic Liver Failure

Abstract

Background: Early prognosis of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is vital for curbing its high mortality. However, patients not yet fulfilling ACLF criteria are still at significant risk of progression and death. This study aims to establish criteria for pre-HBV-ACLF diagnosis.

Methods: The study employed clinical data from patients with HBV-induced acutely deteriorated liver function to develop a new diagnostic criterion, which was then confirmed by a test group.

Results: A cohort of 1682 non-ACLF patients, diagnosed per EASL-ACLF criteria, was analyzed. The random forest model, utilizing the caret package in R, was trained with feature selection via the Boruta algorithm. The model emphasized Total bilirubin (TBIL) and in ternational normalized ratio (INR) as key predictors of progression from severe liver injury (SLI,TB≥85.5 umol/L) to ACLF, with the highest probabilities. The ROC curve analysis identified the cut-off values as 131.5 umol/L for TBIL and 1.35 for INR. Patients with TBIL >131.5 umol/L or INR >1.35 were labeled pre-ACLF-O, while those meeting both criteria were classified as pre-ACLF-A. The pre-ACLF-O criteria showed a sensitivity of 98.3% in the derivation set, underscoring the importance of vigilant clinical monitoring. The pre-ACLF-A criteria predicted ACLF incidence rates of 33.09% in the derivation cohorts.

Conclusions: We strongly advocate for the pre-ACLF-O criteria as an early warning system due to its high sensitivity for detecting potential issues. Notably, the pre-ACLF-A criteria is an effective predictor, accurately foreseeing nearly a third of ACLF cases, underscoring their value in early identification and management of ACLF patients.

Keywords: HBV, Pre-ACLF, Criteria