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Cited 9 time in webofscience Cited 12 time in scopus
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A Model to Predict 1-Month Risk of Transplant or Death in Hepatitis A-Related Acute Liver Failure

Authors
Kim, Jin DongCho, Eun JuAhn, ChoonghyunPark, Sue K.Choi, Jong YoungLee, Han ChuKim, Do YoungChoi, Moon SeokWang, Hee JungKim, In HeeYeon, Jong EunSeo, Yeon SeokTak, Won YoungKim, Moon YoungLee, Heon JuKim, Yun SooJun, Dae WonSohn, Joo HyunKwon, So YoungPark, Sang HoonHeo, JeongJeong, Sook-HyangLee, Jeong-HoonNakayama, NobuakiMochida, SatoshiIdo, AkioTsubouchi, HirohitoTakikawa, HazimeShalimarAcharya, Subrat KumarBernal, WilliamO'Grady, JohnKim, Yoon Jun
Issue Date
Aug-2019
Publisher
John Wiley & Sons Inc.
Citation
Hepatology, v.70, no.2, pp.621 - 629
Indexed
SCIE
SCOPUS
Journal Title
Hepatology
Volume
70
Number
2
Start Page
621
End Page
629
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/1764
DOI
10.1002/hep.30262
ISSN
0270-9139
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.
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Guro Hospital (Department of Gastroenterology and Hepatology, Guro Hospital)
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