Hepatology. 2019;70(2):621-629.
A Model to Predict 1-Month Risk of Transplant or Death in Hepatitis A-Related Acute Liver Failure.
제1저자 김진동/조은주 · 교신저자 김윤준
소속 (28)
- Catholic University Liver Research Center & WHO Collaborating Center of Viral Hepatitis, Catholic University of Korea College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Cheju Halla General Hospital, Jeju, Korea.
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.
- Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea.
- Cancer Research Institute, Seoul National University, Seoul, Korea.
- Department of Internal Medicine, Catholic University of Korea College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
- Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea.
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
- Department of Internal Medicine, Gachon University School of Medicine, Incheon, Korea.
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
- Department of Internal Medicine, Hallym Univesity College of Medicine, Seoul, Korea.
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
- Department of Gastroenterology and Hepatology, Saitama Medical University, Moroyama, Japan.
- Department of Digestive and Life-Style Related Disease, Health Research Course, Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
- Kagoshima City Hospital, Kagoshima, Japan.
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan.
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
- Institute of Liver Studies, King's College Hospital, London, United Kingdom.
Abstract
Acute liver failure (ALF) caused by hepatitis A is a rare but fatal disease. Here, we developed a model to predict outcome in patients with ALF caused by hepatitis A. The derivation set consisted of 294 patients diagnosed with hepatitis A-related ALF (ALFA) from Korea, and a validation set of 56 patients from Japan, India, and United Kingdom. Using a multivariate proportional hazard model, a risk-prediction model (ALFA score) consisting of age, international normalized ratio, bilirubin, ammonia, creatinine, and hemoglobin levels acquired on the day of ALF diagnosis was developed. The ALFA score showed the highest discrimination in the prediction of liver transplant or death at 1 month (c-statistic, 0.87; 95% confidence interval [CI], 0.84-0.92) versus King's College criteria (KCC; c-statistic, 0.56; 95% CI, 0.53-0.59), U.S. Acute Liver Failure Study Group index specific for hepatitis A virus (HAV-ALFSG; c-statistic, 0.70; 95% CI, 0.65-0.76), the new ALFSG index (c-statistic, 0.79; 95% CI, 0.74-0.84), Model for End-Stage Liver Disease (MELD; c-statistic, 0.79; 95% CI, 0.74-0.84), and MELD including sodium (MELD-Na; c-statistic, 0.78; 95% CI, 0.73-0.84) in the derivation set (all P < 0.01). In the validation set, the performance of the ALFA score (c-statistic, 0.84; 95% CI, 0.74-0.94) was significantly better than that of KCC (c-statistic, 0.65; 95% CI, 0.52-0.79), MELD (c-statistic, 0.74; 95% CI, 0.61-0.87), and MELD-Na (c-statistic, 0.72; 95% CI, 0.58-0.85) (all P < 0.05), and better, but not statistically significant, than that of the HAV-ALFSG (c-statistic, 0.76; 95% CI, 0.61-0.90; P = 0.28) and new ALFSG indices (c-statistic, 0.79; 95% CI, 0.65-0.93; P = 0.41). The model was well-calibrated in both sets. Conclusion: Our disease-specific score provides refined prediction of outcome in patients with ALF caused by hepatitis A.
© 2018 by the American Association for the Study of Liver Diseases.
그 밖의 정보
- 출판 형태
- Journal Article, Research Support, Non-U.S. Gov't
- 저널
- Hepatology (Baltimore, Md.) · eISSN 1527-3350
- 전자 출판
- 2019-02-17
- MeSH
- Adult · Female · Hepatitis A / complications · Humans · Liver Failure, Acute / etiology / mortality / surgery · Liver Transplantation / statistics & numerical data · Male · Middle Aged · Models, Statistical* · Prognosis · Risk Assessment · Time Factors
- 연구비
- Korean Association for the Study of the Liver