A short-term prognostic nomogram for HBV-related acute-on-chronic liver failure incorporating serum hBD-1,IL-6 and PALBI score
CHEN Qing
CHEN Xueying
DUAN Xingyuan
Abstract：Objective A short-term prognostic prediction model is constructed for patients with hepatitis B virus(HBV)-acute-on-chronic liver failure(ACLF)based on serum human beta-defensin-1(HBD-1),interleukin-6(IL-6),and platelet-albumin-bilirubin(PALBI)score.Methods A total of 395 patients with HBV-ACLF admitted to our hospital between May 2021 and January 2024 were selected and divided into a death group(175 cases)and a survival group(220 cases)based on their 28-day outcomes.Clinical data were collected,and serum HBD-1 and IL-6 levels were measured by enzyme-linked immunosorbent assay on the second day of admission.The PALBI score was calculated.Univariate analysis and least absolute shrinkage and selection operator(LASSO)regression were used to identify factors influencing the short-term prognosis of HBV-ACLF patients.Multivariable logistic regression was conducted to determine independent risk factors among non-zero feature variables.A short-term prognostic prediction model was constructed using R software based on serum HBD-1,IL-6,and PALBI scores,and internal validation was performed using the concordance index,calibration curve,decision curve,and Hosmer-Lemeshow test.The predictive efficiency of the model was evaluated using the receiver operating characteristic(ROC)curve.Results The 28-day mortality rate of 395 HBV-ACLF patients was 44.30％(175/395).Univariate analysis revealed that ACLF staging,ascites,hepatic encephalopathy,upper gastrointestinal bleeding,neutrophil-to-lymphocyte ratio,total bilirubin,lactate dehydrogenase,albumin,fibrinogen,international normalized ratio(INR),prothrombin activity,HBD-1,IL-6,Child-Turcotte-Pugh(CTP)score,and PALBI score were associated with the short-term prognosis of HBV-ACLF patients(P＜0.05).LASSO regression identified 9 variables with non-zero characteristics.Multivariate unconditional logistic regression showed that ACLF staging,hepatic encephalopathy,upper gastrointestinal bleeding,INR,HBD-1,IL-6,CTP score,and PALBI score were independent risk factors for mortality in HBV-ACLF patients(P＜0.05).A short-term prognostic prediction model was constructed based on serum HBD-1,IL-6,and PALBI scores[Logit(P)=-12.971+1.284(▼)ACLF stage+1.291(▼)hepatic encephalopathy+1.461(▼)upper gastrointestinal bleeding+1.337(▼)INR+0.019(▼)HBD-1+0.064(▼)IL-6+0.434(▼)CTP score+0.240(▼)PALBI score].Internal validation showed a concordance index of 0.934(95％CI:0.932-0.937),good fit between the calibration curve and ideal curve,decision curve close to the two extreme curves,and a Hosmer-Lemeshow test with P＞0.05.The ROC curve indicated that the area under the curve(AUC)of the model for predicting the short-term prognosis of HBV-ACLF patients was 0.934(95％CI:0.905-0.957),with a sensitivity of 86.29％and specificity of 90.00％.Conclusion The short-term prognostic prediction model constructed based on serum HBD-1,IL-6,and PALBI scores demonstrates good predictive efficiency for HBV-ACLF patients.
Keywords：HBV-acute-on-chronic liver failurehuman beta-defensin-1interleukin-6platelet-albumin-bilirubin scoreshort-term prognosisprediction model
Publication Date：2025-04-30
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 116-122 )