Xu et al reported a model for predicting mortality for a patient with HBV-related subacute liver failure. This can help to identify a patient who may benefit from more aggressive management. The authors are from Xi;an Jiaotong University in China.
Patient selection: subacute liver failure associated with HBV
Outcome: 6-month mortality
Parameters:
(1) age in years
(2) hepatic encephalopathy
(3) infection
(4) ascites
(5) MELD score, modified, in range from 0 to 50 (possibly higher, most below 40)
(6) INR
(7) serum total cholesterol in mmol/L
|
Parameter
|
Finding
|
Points
|
|
age in years
|
|
0.1 * (age)
|
|
hepatic encephalopathy
|
no
|
0
|
|
|
yes
|
2.12
|
|
infection
|
no
|
0
|
|
|
yes
|
1.45
|
|
ascites
|
no
|
0
|
|
|
yes
|
1.51
|
|
MELD score
|
|
0.33 * (MELD)
|
|
INR
|
|
1.77 * (INR)
|
|
serum total cholesterol
|
|
-1.19 * (cholesterol)
|
where:
• The equation on page 4 gives unrealistic results. The coefficients given are the odds ratios for the parameters rather than LN(OR). The coefficients used correspond to beta-coefficients in Table 2. Only the items in table 2 with low p values are included.
• The MELD score appears to be the main driver for the score.
value of X =
= SUM(points for all of the parameters) - 15.4
probability of 6-month mortality =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC was 0.94.
