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<p>The prompt and accurate prognostication of acute-on-chronic liver failure (ACLF) patients is crucial for clinical intervention and reducing mortality. This study aimed to develop a novel prognostic model based on pathological changes, with a specific focus on portal vein which is correlated with hepatic pathology. A cohort of 127 ACLF patients was enrolled to develop the prognostic model for 90-day mortality, which was validated in a prospective cohort of 105 ACLF patients. Demographic characteristics, laboratory indicators, and imaging factor portal vein diameter (PVD) were screened, and a nomogram prognostic model was developed using logistic regression. Patients with PVD ≥ 13.4&#xa0;mm had significantly higher mortality (<i>P</i> = 0.047). PVD, age, neutrophil percentage, sex and total bilirubin were identified as independent predictors for the new PVD-based nomogram prognostic model, PANST. The C-index (0.878) of PANST score was higher than Chronic Liver Failure-Consortium-ACLF (CLIF-C ACLF), end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores (0.691, 0.687, 0.639, respectively; <i>P</i> &lt; 0.001). The ROC and decision curves demonstrated that the PANST score was superior to CLIF-C ACLF, MELD and CTP scores. Furthermore, after subgroup analysis, the C-indices of PANST score for hepatitis B virus-related ACLF (HBV-ACLF) and non-HBV-ACLF patients (0.842,0.950) were significantly higher than those of CLIF-C ACLF score (0.772, 0.750; <i>P</i> &lt; 0.05), MELD score (0.730, 0.608; all <i>P</i> &lt; 0.05) and CTP score (0.701,0.513; all <i>P</i> &lt; 0.05). These results were confirmed in the validation cohort. PVD was an independent predictor, and the PANST score, a novel prognostic model based on PVD can accurately predict 90-day mortality in ACLF patients.</p>

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A novel prognostic model based on portal vein diameter for patients with acute-on-chronic liver failure

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月26日

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  • Qiao Zhang,
  • Yushan Liu,
  • Xiaonan Wu,
  • Juan Li,
  • Yamin Wang,
  • Xiaoli Zhang,
  • Hai Li,
  • Jinjun Chen,
  • Chenxia Li,
  • Jian Yang,
  • Yingren Zhao,
  • Taotao Yan,
  • Yingli He

摘要

The prompt and accurate prognostication of acute-on-chronic liver failure (ACLF) patients is crucial for clinical intervention and reducing mortality. This study aimed to develop a novel prognostic model based on pathological changes, with a specific focus on portal vein which is correlated with hepatic pathology. A cohort of 127 ACLF patients was enrolled to develop the prognostic model for 90-day mortality, which was validated in a prospective cohort of 105 ACLF patients. Demographic characteristics, laboratory indicators, and imaging factor portal vein diameter (PVD) were screened, and a nomogram prognostic model was developed using logistic regression. Patients with PVD ≥ 13.4 mm had significantly higher mortality (P = 0.047). PVD, age, neutrophil percentage, sex and total bilirubin were identified as independent predictors for the new PVD-based nomogram prognostic model, PANST. The C-index (0.878) of PANST score was higher than Chronic Liver Failure-Consortium-ACLF (CLIF-C ACLF), end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores (0.691, 0.687, 0.639, respectively; P < 0.001). The ROC and decision curves demonstrated that the PANST score was superior to CLIF-C ACLF, MELD and CTP scores. Furthermore, after subgroup analysis, the C-indices of PANST score for hepatitis B virus-related ACLF (HBV-ACLF) and non-HBV-ACLF patients (0.842,0.950) were significantly higher than those of CLIF-C ACLF score (0.772, 0.750; P < 0.05), MELD score (0.730, 0.608; all P < 0.05) and CTP score (0.701,0.513; all P < 0.05). These results were confirmed in the validation cohort. PVD was an independent predictor, and the PANST score, a novel prognostic model based on PVD can accurately predict 90-day mortality in ACLF patients.