Clinical Prediction Models for Hepatitis B Virus-related Acute-on-chronic Liver Failure:A Technical Report

Background and Aims:It is critical but challenging to predict the prognosis of hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF).This study systematically summarized and evaluated the quality and performance of available clinical prediction models(CPMs).Methods:A keyword search of articles on HBV-ACLF CPMs published in PubMed from January 1995 to April 2020 was performed.Both the quality and performance of the CPMs were assessed.Results:Fifty-two CPMs were identified,of which 31 were HBV-ACLF specific.The modeling data were mostly derived from retrospective(83.87%)and single-center(96.77%)cohorts,with sample sizes ranging from 46 to 1,202.Three-month mortality was the most common endpoint.The Asian Pacific Association for the Study of the Liver consensus(51.92%)and Chinese Medical Association liver failure guidelines(40.38%)were commonly used for HBV-ACLF diagnosis.Serum bilirubin(67.74%),the international normalized ratio(54.84%),and hepatic encephalopathy(51.61%)were the most frequent variables used in models.Model discrimination was commonly evaluated(88.46%),but model calibration was seldom performed.The model for end-stage liver disease score was the most widely used(84.62%);however,varying performance was reported among the studies.Conclusions:Substantial limitations lie in the quality of HBV-ACLF-specific CPMs.Disease severity of study populations may impact model performance.The clinical utility of CPMs in predicting short-term prognosis of HBV-ACLF remains to be undefined.