Wirusowe zapalenie wątroby typu b – Rokowania, prognozy i postęp choroby

Wirusowe zapalenie wątroby typu b
Rokowania, prognozy i postęp choroby

Przewlekłe zakażenie wirusem zapalenia wątroby typu B (HBV) charakteryzuje się złożonym przebiegiem klinicznym, obejmującym fazy immunotolerancji, oczyszczania immunologicznego oraz możliwe przejście do marskości i raka wątrobowokomórkowego (HCC). Kluczowymi czynnikami prognostycznymi są m.in. stężenie HBV DNA (powyżej 10⁴ kopii/ml wiąże się ze zwiększoną śmiertelnością), obecność antygenu e (HBeAg), wiek pacjenta, oraz stopień zaawansowania choroby wątroby. Modele prognostyczne, takie jak HITAS, HBV-ACLFD, COSSH-ACLFs oraz klasyczne skale MELD i CTP, wykazują różną skuteczność w przewidywaniu krótkoterminowej śmiertelności u pacjentów z ostrą niewydolnością wątroby na tle HBV (ACLF), z AUROC sięgającym nawet 0,89 dla COSSH-ACLFs. W terapii celem jest maksymalne obniżenie wiremii do poziomu poniżej 10³-10⁴ kopii/ml, co koreluje z lepszym rokowaniem i zmniejszeniem ryzyka progresji do marskości i HCC.

Wirusowe zapalenie wątroby typu B – Prognozy i przewidywanie wyników leczenia

Naturalna historia i ogólne rokowanie WZW B
Czynniki predykcyjne niekorzystnego rokowania
Modele prognostyczne w ostrej niewydolności wątroby na tle przewlekłego zakażenia HBV
Biomarkery serologiczne w prognozowaniu WZW B
Czynniki prognostyczne raka wątrobowokomórkowego związanego z HBV
Modele uczenia maszynowego w prognozowaniu
Znaczenie ostrych zaostrzeń przewlekłego WZW B
Znaczenie monitorowania dla poprawy rokowania
Kolejne rozdziały

Wirusowe zapalenie wątroby typu B – Prognozy i przewidywanie wyników leczenia

Przewidywanie przebiegu i rokowania u pacjentów z wirusowym zapaleniem wątroby typu B (WZW B) stanowi istotne wyzwanie kliniczne. Identyfikacja czynników prognostycznych ma kluczowe znaczenie dla podejmowania odpowiednich decyzji terapeutycznych i poprawy wyników leczenia. Wczesne określenie rokowania umożliwia personalizację postępowania terapeutycznego oraz identyfikację pacjentów wymagających intensywnego nadzoru lub pilnej interwencji.¹²

Naturalna historia i ogólne rokowanie WZW B

Zakażenie wirusem zapalenia wątroby typu B może prowadzić do dwóch możliwych wyników: ostrego lub przewlekłego zakażenia. U około 15% dorosłych zakażonych HBV rozwija się zakażenie przewlekłe, podczas gdy pozostali eliminują zakażenie. Wśród dzieci zakażonych HBV w wieku 1-5 lat, 25-50% rozwija zakażenie przewlekłe, podobnie jak 90% niemowląt zakażonych przy urodzeniu, co sugeruje zależność wyniku zakażenia od wieku.¹

Wirus zapalenia wątroby typu B zwykle pozostaje w organizmie przez około 1-3 miesięcy i stanowi infekcję ostrą. Jednakże u około 5% zakażonych dorosłych infekcja ma charakter przewlekły i utrzymuje się przez sześć lub więcej miesięcy. Około 20% osób z długotrwałym zakażeniem rozwinie chorobę wątroby z bliznowaceniem lub marskością wątroby. Wśród osób z marskością wątroby, około 10% zachoruje na raka wątroby.¹

Przewlekłe zakażenie HBV jest definiowane jako niepowodzenie w eliminacji HBsAg z surowicy osoby zakażonej HBV przez ponad 6 miesięcy. W naturalnej historii przewlekłego zakażenia HBV występują trzy powszechne fazy. Pierwsza faza, nazywana fazą immunotolerancji, występuje gdy zakażenie zostaje nabyte w dzieciństwie i trwa 1-2 dekady. Osoby w tej fazie mają wysokie poziomy HBV DNA w surowicy z prawidłowymi poziomami ALT, ponieważ zmiany martwiczo-zapalne w wątrobie są minimalne.¹

Czynniki predykcyjne niekorzystnego rokowania

Różne badania zidentyfikowały odmienne czynniki związane z niekorzystnymi wynikami. Na przykład, Niederau i współpracownicy, w kohorcie pacjentów europejskich, zidentyfikowali brak eliminacji antygenu e wirusa zapalenia wątroby typu B (HBeAg) jako predyktor zmniejszonej przeżywalności. Inni badacze wskazali starszy wiek, obecność marskości wątroby i utrzymujące się podwyższone poziomy aminotransferazy alaninowej (ALT) jako niekorzystne oznaki prognostyczne w kohorcie pacjentów z przeciwciałami przeciwko antygenowi e wirusa zapalenia wątroby (anty-HBe).¹

Najlepszym predyktorem niekorzystnego wyniku u nosiciela zapalenia wątroby typu B jest stężenie HBV DNA. Im wyższe stężenie HBV DNA, tym wyższa częstość występowania niekorzystnych wyników. Wyniki te, wraz z danymi Yuena i współpracowników, potwierdzają koncepcję, że pacjenci z prawidłowymi poziomami ALT nie mogą być już wykluczani z terapii oraz że do określenia kwalifikacji do terapii należy stosować kryteria inne niż ALT. Im wyższe stężenie HBV DNA (powyżej 10⁴ kopii/ml), tym większa śmiertelność. Leczenie powinno być ukierunkowane na maksymalne hamowanie HBV DNA, do poziomu poniżej 10⁴, a najlepiej poniżej 10³.¹

W zależności od charakteru odpowiedzi immunologicznej podczas fazy oczyszczania immunologicznego, pacjenci z przewlekłym zakażeniem HBV mogą rozwinąć zwłóknienie lub marskość wątroby. Po powtarzających się próbach odpowiedzi immunologicznej, replikacja wirusa zostanie zahamowana z powodu zmniejszonej liczby zakażonych hepatocytów, a następnie pacjenci z przewlekłym WZW B często serokonwertują do przeciwciał anty-HBe. Około 30% pacjentów przejdzie reaktywację z okazjonalnym powrotem do HBeAg-dodatniości, co jest nazywane HBeAg-ujemnym przewlekłym zakażeniem HBV.¹

Modele prognostyczne w ostrej niewydolności wątroby na tle przewlekłego zakażenia HBV

Ostra niewydolność wątroby na tle przewlekłego zakażenia (ACLF) związanego z HBV stanowi poważne wyzwanie kliniczne. Wczesne przewidywanie krótkoterminowych wyników jest niezbędne dla właściwego zarządzania przypadkami HBV-ACLF.¹²

Opracowano kilka modeli prognostycznych do przewidywania wyników w HBV-ACLF:

Model HITAS – skonstruowany na podstawie pięciu niezależnych predyktorów: stopnia encefalopatii wątrobowej (HE), INR, bilirubiny całkowitej (TBIL), wieku i statusu zespołu ogólnoustrojowej reakcji zapalnej (SIRS). Wykazuje znacznie lepszą wartość predykcyjną niż skala MELD i CTP.¹
Model HBV-ACLFD – może dokładnie przewidywać 30-dniową śmiertelność u pacjentów z HBV-ACLF, co pomaga w wyborze odpowiednich procedur klinicznych. Jego wydajność okazała się być lepsza niż skala MELD, skala MELD-Na i skala CTP (P<0,0001).¹²
Model MELD i jego pochodne – Wykazano, że wynik MELD pod koniec 2 tygodni leczenia skutecznie klasyfikuje pacjentów z ACLF-HBV według ryzyka śmiertelności 3-miesięcznej, co wykazano przez wysokie statystyki c (0,8). Podobnie, wyniki MESO, iMELD i MELD-Na pod koniec 2 tygodni leczenia oraz wyniki MELD i MESO wykazały dobry potencjał predykcyjny dla śmiertelności 3-miesięcznej.¹²

Dla przewidywania złego rokowania u pacjentów z ACLF, skala COSSH-ACLFs wykazała znacząco wyższy wskaźnik AUROC w porównaniu ze skalami CLIF-C ACLFs, CLIF-C OFs, MELD i CTP (odpowiednio 0,89, 0,83, 0,81, 0,67 i 0,58; wszystkie p<0,05). Etapowe zastosowanie skali CTP i COSSH-ACLFs może przewidywać rokowanie u pacjentów z przewlekłym zakażeniem HBV z ostrym zakażeniem HEV.¹

Warto zauważyć, że modele prognostyczne wykazują zróżnicowaną skuteczność u pacjentów z marskością i bez marskości wątroby. Przewidywanie krótkoterminowego wyniku HBV-ACLF przez modele CPM jest optymalne u pacjentów bez marskości, ale ograniczone u pacjentów z marskością, częściowo z powodu powikłanych wodobrzusza lub infekcji.¹

Biomarkery serologiczne w prognozowaniu WZW B

Wraz z pojawieniem się nowych terapii przeciwko wirusowi zapalenia wątroby typu B (HBV), pilnie potrzebne są nowe biomarkery do monitorowania odpowiedzi wirusowych i gospodarza. Obecnie dostępnych jest tylko kilka biomarkerów do monitorowania lub przewidywania progresji choroby i odpowiedzi na leczenie HBV.¹

Wśród ważnych biomarkerów serologicznych należy wymienić:

Antygen związany z rdzeniem HBV (HBcrAg) – skuteczne narzędzie do kategoryzacji pacjentów z HBeAg-ujemnym przewlekłym zapaleniem wątroby typu B. Poziomy HBcrAg przewidują progresję do marskości wątroby u nosicieli zapalenia wątroby typu B. Wysoki poziom HBcrAg jest związany ze zwiększonym ryzykiem raka wątrobowokomórkowego u pacjentów z przewlekłym zakażeniem HBV o średnim ładunku wirusowym.¹²
RNA wirusa zapalenia wątroby typu B – poziomy w surowicy jako wczesny predyktor serokonwersji antygenu e zapalenia wątroby typu B podczas leczenia inhibitorami polimerazy. Niski poziom HBV RNA w surowicy podczas leczenia przewiduje początkową odpowiedź wirusologiczną u pacjentów z przewlekłym zapaleniem wątroby typu B otrzymujących terapię analogami nukleozydowymi.¹²

Status HBV pgRNA po roku leczenia analogami nukleozyd(t)owymi (NA) ma znaczący wpływ na rokowanie. Pacjenci, którzy byli HBV pgRNA-dodatni po leczeniu NA, mieli mniejsze prawdopodobieństwo osiągnięcia eliminacji HBeAg i potrzebowali więcej czasu na osiągnięcie eliminacji HBeAg i niewykrywalnego poziomu HBV DNA niż ci, którzy byli HBV pgRNA-ujemni po roku leczenia NA.¹

Czynniki prognostyczne raka wątrobowokomórkowego związanego z HBV

Przewlekłe zakażenie wirusem zapalenia wątroby typu B (HBV) przyczynia się do 75% przypadków raka wątrobowokomórkowego (HCC). Wczesne i dokładne przewidywanie ryzyka HCC u osób zakażonych HBV jest pilnie potrzebne.¹²

Kluczowe czynniki prognostyczne rozwoju HCC to:

Wysoki poziom wiremii – najbardziej wiarygodny wskaźnik replikacji wirusa w przewidywaniu rozwoju HCC.¹
Genotyp HBV – genotyp C jest ściśle związany z HCC u pacjentów z marskością wątroby w wieku ≥50 lat, podczas gdy genotyp B jest związany z rozwojem HCC u młodych pacjentów bez marskości i z nawrotem pooperacyjnym HCC.¹²
Mutacje wirusa – różne podgenotypy HBV mają odrębne wzorce mutacji, które są wyraźnie związane ze zwiększonym ryzykiem HCC. Mutacje kumulują się podczas przewlekłego zakażenia HBV i przewidują wystąpienie HCC.¹
Wiek – wyniki badań wykazały, że wiek był jednym z najważniejszych czynników ryzyka HCC.¹
Biomarkery – zwiększony wiek, BLR, D-Dimer, AST/ALT, GGT i AFP były ważnymi predyktorami ryzyka HCC u pacjentów z przewlekłym WZW B.¹

Wysoki poziom wiremii jest najważniejszym czynnikiem w przewidywaniu złego rokowania u pacjentów z HCC związanym z HBV, dlatego zdecydowanie zaleca się leczenie przeciwwirusowe po resekcji chirurgicznej. Genotyp C był czynnikiem ryzyka niezależnie związanym ze złym rokowaniem. Wysoki poziom IL-6 w surowicy przewiduje przyszłe wystąpienie HCC u pacjentów z przewlekłym WZW B.¹

Modele uczenia maszynowego w prognozowaniu

Zaawansowane modele uczenia maszynowego (ML) zyskują coraz większe znaczenie w prognozowaniu przebiegu WZW B i jego powikłań. Opracowano i wewnętrznie zwalidowano model Random Forest (RF) do przewidywania ryzyka HCC u pacjentów z przewlekłym zapaleniem wątroby typu B (CHB).¹²

Model RF wykazuje najlepszą wydajność w przewidywaniu ryzyka HCC u pacjentów z CHB w zestawie treningowym [AUC: 0,996, 95% przedział ufności (CI) (0,991-0,999)] i wewnętrznym zestawie walidacyjnym [AUC: 0,993, 95% CI (0,986-1,000)]. Modele ML mogą być stosowane jako narzędzie do przewidywania ryzyka HCC u pacjentów z CHB.¹

Badania pokazują potencjał kompleksowego zrozumienia progresji HBV poprzez analizę predykcyjną i identyfikują najbardziej wskazujące biomarkery krwi, które mogą służyć jako biomarkery, które można wykorzystać w immunoterapii.¹

Znaczenie ostrych zaostrzeń przewlekłego WZW B

Ostre zaostrzenia przewlekłego zapalenia wątroby typu B mogą mieć istotny wpływ na rokowanie. Diagnoza ciężkich ostrych zaostrzeń przewlekłego zapalenia wątroby typu B jest kierowana przez podwyższone poziomy enzymu aminotransferazy alaninowej niemal pięciokrotnie przekraczające górną granicę normy podczas przewlekłej fazy zakażenia wirusem zapalenia wątroby typu B, poprzedzone podwyższonymi poziomami antygenu powierzchniowego zapalenia wątroby typu B i DNA wirusa zapalenia wątroby typu B (HBV DNA).¹

Martwica mostkowa wątroby związana z poziomami alfa-fetoproteiny 100 ng/ml lub zmniejszającymi się poziomami HBV DNA podczas ostrych zaostrzeń są patognomoniczne dla lepszego immunologicznego oczyszczania HBV, które ostatecznie prowadzi do seroklirensu. Ciężkie lub powtarzające się ostre zaostrzenia mogą prowadzić do dekompensacji wątroby i marskości wątroby. Dlatego ważne jest zapobieganie ostrym zaostrzeniom zapalenia wątroby typu B poprzez odpowiednie podawanie leków przeciwwirusowych.¹

Zasadniczym czynnikiem ryzyka ciężkich ostrych zaostrzeń HBV podczas zakażenia CHB pozostaje nasilenie pierwotnie istniejącej choroby wątroby. Bilirubina w surowicy i aktywność protrombiny są istotnymi predyktorami wyników klinicznych u pacjentów z ciężkimi ostrymi zaostrzeniami lub zaostrzeniem CHB.¹

Badanie przeprowadzone w Hongkongu (N=46) u pacjentów z CHB z ostrym zaostrzeniem bez przypadków encefalopatii wątrobowej wykazało, że 24% pacjentów zmarło lub otrzymało przeszczep wątroby podczas pobytu w szpitalu. Tacy pacjenci powinni być regularnie monitorowani raz lub dwa razy w tygodniu pod kątem enzymów ALT w surowicy i poziomów bilirubiny oraz pomiaru czasu protrombinowego, aby wykryć pogorszenie kliniczne lub dekompensację wątroby w odpowiednim czasie na natychmiastową terapię przeciwwirusową w celu zapobiegania lub ratowania.¹

Definitywnym leczeniem ciężkiego zaostrzenia przewlekłego WZW B z ostrą niewydolnością wątroby na tle przewlekłej choroby wątroby (ACLF) jest przeszczep wątroby z 5-letnim przeżyciem wynoszącym 90%.¹

Znaczenie monitorowania dla poprawy rokowania

Zwiększenie poziomów enzymów aminotransferazy jest wskaźnikiem aktywności immunologicznie zapośredniczonej cytoliza hepatocytów, która jest związana ze zwiększonym oczyszczaniem HBV. Pacjenci z poziomami ALT dwa-pięć razy wyższymi niż górna granica normy (ULN) z mniejszym spontanicznym oczyszczeniem HBV muszą rozpocząć terapię lekami przeciw HBV, aby zapobiec wystąpieniu zaostrzeń zapalenia wątroby typu B i związanych z tym powikłań.¹

Wczesne i dokładne przewidywanie ryzyka HCC u osób zakażonych HBV jest pilnie potrzebne. Kluczem do skutecznego programu nadzoru nad rakiem wątroby, który zapewnia wczesną diagnozę i poprawia rokowanie, jest posiadanie prostych i dokładnych narzędzi do identyfikacji pacjentów z różnymi ryzykami raka wątroby, zmniejszenia obciążenia pacjentów oraz optymalizacji alokacji zasobów w celu zwiększenia częstotliwości nadzoru w grupach wysokiego ryzyka.¹

Ostatecznie można osiągnąć zindywidualizowane monitorowanie pacjentów pod kątem ryzyka raka wątroby, poprawiając w ten sposób wczesną diagnozę i leczenie raka wątroby, a ostatecznie zmniejszając śmiertelność.¹

Model prognostyczny	Główne komponenty	Zastosowanie kliniczne	Skuteczność predykcyjna
MELD	Bilirubina, INR, kreatynina	Przewidywanie 3-miesięcznej śmiertelności w ACLF-HBV	AUROC 0,8 (po 2 tygodniach leczenia)
MELD-Na	Komponenty MELD + sód	Przewidywanie 3-miesięcznej śmiertelności w ACLF-HBV	AUROC 0,728
MESO	Współczynnik MELD:sód	Przewidywanie 3-miesięcznej śmiertelności w ACLF-HBV	AUROC 0,796
iMELD	Zintegrowany MELD	Przewidywanie 3-miesięcznej śmiertelności w ACLF-HBV	AUROC 0,758
HITAS	HE, INR, TBIL, wiek, SIRS	Przewidywanie rokowania w HBVACLF po terapii glukokortykoidami	Lepsza niż MELD i CTP
HBV-ACLFD	Dynamiczny model dla ACLF	Przewidywanie 30-dniowej śmiertelności w HBV-ACLF	AUROC 0,848 (kohorta derywacyjna) i 0,813 (kohorta walidacyjna)
COSSH-ACLFs	Model dla ACLF w Chinach	Przewidywanie złego rokowania w ACLF	AUROC 0,89
CTP + COSSH-ACLFs	Algorytm sekwencyjny	Przewidywanie rokowania w przewlekłym zakażeniu HBV z ostrym HEV	Skuteczna stratyfikacja ryzyka
Model Random Forest (RF)	Algorytm uczenia maszynowego	Przewidywanie ryzyka HCC w CHB	AUC 0,996 (zestaw treningowy) i 0,993 (zestaw walidacyjny)

¹²³⁴⁵⁶⁷⁸

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Materiały źródłowe

#1 Predicting survival in hepatitis B
https://pmc.ncbi.nlm.nih.gov/articles/PMC1774728/
Predictors of survival in chronic hepatitis B infection are surprisingly not well described. Various studies have identified different factors that were associated with adverse outcomes. For example, Niederau and colleagues, in a cohort of European patients, identified lack of clearance of hepatitis B e antigen (HBeAg) as a predictor of decreased survival. […] Others have identified older age, presence of cirrhosis, and the persistence of alanine aminotransferase (ALT) elevations as adverse prognostic signs in an antibody to hepatitis B e antigen (anti-HBe) positive cohort. […] The best predictor of an adverse outcome in a hepatitis B carrier was the HBV DNA concentration. The higher the HBV DNA the higher the incidence of an adverse outcome. […] These results, together with the data of Yuen and colleagues, support the concept that patients with normal ALT levels can no longer be excluded from therapy, and that criteria other than the ALT must be used to determine eligibility for therapy. […] The higher the HBV DNA concentration (above 104 copies/ml), the greater the mortality. […] Treatment should be aimed at suppressing HBV DNA maximally, to below 104, and preferably to below 103.
#1 Hepatitis B virus infection: An insight into infection outcomes and recent treatment options
https://pmc.ncbi.nlm.nih.gov/articles/PMC4585049/
Hepadnavirus infection gives rise to two possible outcomes; acute or chronic infection. In humans, 15 % of adults infected with HBV develop chronic infection, while the remainder clears the infection. Approximately 25-50 % of children infected with HBV at ages 1-5 develop chronic infection, as do 90 % of infants infected at birth, suggesting an age-dependent infection outcome. […] Chronic HBV infection is defined as the failure to clear HBsAg from the serum of a HBV-infected individual for more than 6 months. There are three common phases in the natural history of chronic HBV infection. The first phase is called the immune tolerance phase and this occurs when the infection is contracted during childhood and lasts for 1-2 decades. Individuals in this phase have high levels of serum HBV DNA with normal ALT levels as the liver necroinflammatory changes are minimal.
#1 Azthena logo with the word Azthena
https://www.news-medical.net/health/Hepatitis-B-Prognosis.aspx
The hepatitis B virus usually only stays in the system for around one to three months and is therefore an acute infection. However, in around 1 in 20 affected adults, the infection is chronic and stays in the body for six months or more. About 20% of people who develop long-term infection will develop liver disease and suffer from scarring or cirrhosis of the liver. Around 10% of those who develop cirrhosis will go on to develop liver cancer. […] Around 10% of individuals with liver cirrhosis go on to develop liver cancer. […] This is a rare complication of acute hepatitis B where the immune system attacks the liver and causes severe damage. The condition affects around 1 in 100 adults who have chronic hepatitis B.
#1 Hepatitis B virus infection: An insight into infection outcomes and recent treatment options
https://pmc.ncbi.nlm.nih.gov/articles/PMC4585049/
Based on the nature of the immune response during the immune clearance phase, chronically HBV infected patients may develop fibrosis or cirrhosis of the liver. After repeated attempts of immune response, virus replication will be suppressed due to the reduced number of infected hepatocytes and then the CHB patients often seroconvert to anti-HBe antibodies. […] Approximately 30 % patients will undergo reactivation with occasional reversion to HBeAg-positivity. Reactivation after the sero-conversion to anti-HBe antibodies is called HBeAg-negative chronic HBV infection. Some think that it is misleading to call reactivation the fourth phase because some patients may have continued liver damage and elevated ALT levels even after sero-converting anti-HBe antibodies.
#1 Early prediction model for prognosis of patients with hepatitis-B-virus-related acute-on-chronic liver failure received glucocorticoid therapy | European Journal of Medical Research | Full Text
https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-022-00891-w
Early prediction for short-term prognosis is essential for the management of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). […] We proposed a HITAS score, which was an early prediction model for the prognosis of HBVACLF. It might be used to identify HBVACLF patients with favorable responses to glucocorticoid treatment. […] The HITAS score was constructed by five independent predictors: HE grade, INR, TBIL, age and SIRS status. It showed significantly better predictive value than the MELD score and CTP score. Using the cutoff points of 2.5 and 3.47, the HITAS score identified patients that have low, intermediate, and high risks of death. Therefore, it might be used to identify HBVACLF patients with favorable responses to glucocorticoid treatment. […] In conclusion, we constructed a non-invasive model to predict the 90-day mortality in patients with HBVACLF received glucocorticoid treatment. It can stratify the risks of death in patients with HBVACLF and might be used to identify HBVACLF patients with favorable responses to glucocorticoid treatment.
#1 A novel dynamic model for predicting outcome in patients with hepatitis B virus related acute-on-chronic liver failure | Oncotarget
https://www.oncotarget.com/article/22447/text/
Aim: It is challenging to predict the outcome of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) through existing prognostic models. Our aim was to establish a novel dynamic model to improve the predictive efficiency of 30-day mortality in HBV-ACLF patients. […] The HBV-ACLFD model can accurately predict 30-day mortality in patients with HBV-ACLF, which is helpful to select appropriate clinical procedures, so as to relieve the social and economic burden. […] The performance of the HBV-ACLFD model appeared to be superior to MELD score, MELD-Na score and CTP score (P0.0001). […] The results of our research showed that the HBV-ACLFD model exhibited excellent discrimination and almost the same performance in two cohorts (AUROC 0.848 in the derivation cohort and 0.813 in the validation cohort).
#1
https://journals.lww.com/cmj/fulltext/2012/07010/comparison_of_four_prognostic_models_and_a_new.6.aspx
Acute-on-chronic hepatitis B liver failure (ACLF-HBV) is a clinically severe disease associated with major life-threatening complications including hepatic encephalopathy and hepatorenal syndrome. The aim of this study was to evaluate the short-term prognostic predictability of the model for end-stage liver disease (MELD), MELD-based indices, and their dynamic changes in patients with ACLF-HBV, and to establish a new model for predicting the prognosis of ACLF-HBV. […] The 3-month mortality was 43.6%. The largest concordance (c) statistic predicting 3-month mortality was the MELD score at the end of 2 weeks of admission (0.8), followed by the MELD:sodium ratio (MESO) (0.796) and integrated MELD (iMELD) (0.758) scores, MELD (0.752), MESO (0.729), and MELD plus sodium (MELD-Na) (0.728) scores.
#1 Noninvasive models for predicting poor prognosis of chronic HBV infection patients precipitating acute HEV infection | Scientific Reports
https://www.nature.com/articles/s41598-020-59670-4
Hepatitis E virus (HEV) infection contributes to a considerable proportion of acute-on-chronic liver failure (ACLF) in patients with chronic hepatitis B virus (HBV) infection. This study aimed to predict the prognosis of chronic HBV infection patients precipitating acute HEV infection. […] For predicting the poor prognosis of ACLF patients, the COSSH-ACLFs yielded a significantly higher AUROC compared with CLIF-C ACLFs, CLIF-C OFs, MELD score, and CTP score (0.89, 0.83, 0.81, 0.67, and 0.58, respectively; all p<0.05). [...] In conclusion, the stepwise application of CTP score and COSSH-ACLFs can predict the prognosis of chronic HBV infection patients precipitating acute HEV infection. [...] The CTP score is the best model for predicting the development of ACLF in chronic HBV infection patients precipitating acute HEV infection. The COSSH-ACLFs is the best model for predicting the poor outcome of ACLF patients. The CTP-COSSH-ACLFs algorithm, which sequentially combines CTP-score and COSSH-ACLFs, can discriminate patients at low risk of developing ACLF with excellent prognosis from those at high risk of developing ACLF with impaired prognosis and need specialized care.
#1 Frontiers | Prognosis prediction performs better in patients with non-cirrhosis hepatitis B virus-related acute-on-chronic liver failure than those with cirrhosis
https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2022.1013439/full
Prognosis prediction performs better in patients with non-cirrhosis hepatitis B virus-related acute-on-chronic liver failure than those with cirrhosis. […] The accurate prediction of the outcome of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is impeded by population heterogeneity. […] Predicting the short-term outcome of HBV-ACLF by CPMs is optimal in patients without cirrhosis but limited in those with cirrhosis, at least partially due to the complicated ascites or infections. […] Each prognostic model had better performance in HBV-ACLF patients without cirrhosis than those with cirrhosis in the study which is consistent with the study of Dong et al. (2020). […] Our data revealed a differential performance of common scoring models in predicting short-term mortality between HBV-ACLF patients with and without cirrhosis. Common CPMs reached optimal performance in patients without cirrhosis.
#1 A roadmap for serum biomarkers for hepatitis B virus: current status and future outlook | Nature Reviews Gastroenterology & Hepatology
https://www.nature.com/articles/s41575-022-00649-z
As new therapies for hepatitis B virus (HBV) infection become available, new biomarkers to monitor viral and host responses are urgently needed. […] Currently, only a few biomarkers are available for monitoring or predicting HBV disease progression and treatment response. […] The clinical utility of both classic and emerging viral and immunological serum biomarkers with respect to the course of infection, disease progression, and response to current and emerging treatments was appraised. […] This Roadmap summarizes the strengths, weaknesses, opportunities and challenges of HBV biomarkers. […] This Roadmap provides suggestions of the way forward to advance the biomarkers required to fast-track an HBV cure for all, irrespective of resources, HBV genotype or disease stage. […] Serum hepatitis B core-related antigen is an effective tool to categorize patients with HBeAg-negative chronic hepatitis B.
#1 A roadmap for serum biomarkers for hepatitis B virus: current status and future outlook | Nature Reviews Gastroenterology & Hepatology
https://www.nature.com/articles/s41575-022-00649-z
Hepatitis B core-related antigen levels predict progression to liver cirrhosis in hepatitis B carriers. […] High level of hepatitis B core-related antigen associated with increased risk of hepatocellular carcinoma in patients with chronic HBV infection of intermediate viral load. […] Serum hepatitis B virus RNA levels as an early predictor of hepatitis B envelope antigen seroconversion during treatment with polymerase inhibitors. […] On-treatment low serum HBV RNA level predicts initial virological response in chronic hepatitis B patients receiving nucleoside analogue therapy.
#1 Treatment Response and Long-Term Prognosis Predicted by HBV pgRNA Status – Infectious Disease Advisor
https://www.infectiousdiseaseadvisor.com/news/treatment-response-and-long-term-prognosis-predicted-by-hbv-pgrna-status/
Hepatitis B virus (HBV) DNA replication was suppressed and liver inflammation improved in patients with chronic HBV who were treated with long-term nucleos(t)ide analogue (NA) therapy: After 1 year of NA treatment, patients who were HBV pregenomic RNA (pgRNA)-positive required more time to achieve an undetectable HBV DNA load and hepatitis B e antigen (HBeAg) clearance than patients who were HBV pgRNA-negative, according to a study published in the Journal of Viral Hepatitis. […] After treatment, HBV pgRNA status was significantly different between participants who did achieve HBeAg clearance compared with those who did not (=78), and the logistic regression model showed an association between HBV pgRNA positivity and an increased risk of not clearing HBeAg (hazard ratio, 6.69; 95% CI, 1.88-23.84). […] Patients who were HBV pgRNA-positive after NA treatment were less likely to achieve HBeAg clearance and needed more time to achieve HBeAg clearance and an undetectable HBV DNA load than those who were HBV pgRNA-negative after 1 year of NA treatment.
#1 Factors predicting occurrence and prognosis of hepatitis-B-virus-related hepatocellular carcinoma
https://wjgnet.com/1007-9327/full/v17/i38/4258.htm
Factors predicting occurrence and prognosis of hepatitis-B-virus-related hepatocellular carcinoma. […] Chronic hepatitis B virus (HBV) infection contributes to 75% of HCC cases. […] High serum viral load is the most reliable indicator of viral replication in predicting development of HCC. […] HBV genotype C is closely associated with HCC in cirrhotic patients aged 50 years, whereas genotype B is associated with development of HCC in non-cirrhotic young patients and postoperative relapse of HCC. […] Different HBV subgenotypes have distinct patterns of mutations, which are clearly associated with increased risk of HCC. […] Mutations accumulate during chronic HBV infection and predict occurrence of HCC. […] HBV load, genotype C, viral mutations and expression of inflammatory molecules in HBV-related HCC tissues are significantly associated with poor prognosis.
#1 Development and validation of an interpretable machine learning model for predicting the risk of hepatocellular carcinoma in patients with chronic hepatitis B: a case-control study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03697-2
The present study aimed to develop and validate an interpretable ML model for predicting the risk of HCC in patients with CHB. […] The main outcome index of this study was whether the patient had HBV-related HCC. […] Five predictive models were developed and internally validated using ML algorithms to assess the risk of HCC in patients with CHB. […] The results show that the RF model outperforms the ANN in terms of sensitivity, specificity and AUC, indicating that the RF model is more robust in processing limited sample size and high noise data. […] The results of this study showed that age was one of the most important risk factors for HCC. […] Therefore, increased age, BLR, D-Dimer, AST/ALT, GGT, and AFP were important predictors of the risk of HCC in CHB patients. […] We identified age, BLR, D-Dimer, AST/ALT, GGT, and AFP as predictors of HCC risk in CHB patients and constructed and validated an interpretable ML model to assess the risk of HCC in CHB patients.
#1 Factors predicting occurrence and prognosis of hepatitis-B-virus-related hepatocellular carcinoma
https://wjgnet.com/1007-9327/full/v17/i38/4258.htm
Imbalance between intratumoral CD8+ T cells and regulatory T cells or Th1 and Th2 cytokines in peritumoral tissues can predict prognosis of HBV-related HCC. […] These factors are important for developing active prevention and surveillance of HBV-infected subjects who are more likely to develop HCC, or for tailoring suitable treatment to improve survival or postpone postoperative recurrence of HCC. […] High viral load is the most reliable factor in predicting poor prognosis of the patients with HBV-related HCC, therefore, antiviral treatment after surgical resection is highly recommended. […] Genotype C was a risk factor independently associated with poor prognosis. […] High serum level of IL-6 predicts future occurrence of HCC in patients with CHB.
#1 Development and validation of an interpretable machine learning model for predicting the risk of hepatocellular carcinoma in patients with chronic hepatitis B: a case-control study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03697-2
The aim of this study was to develop and internally validate an interpretable machine learning (ML) model for predicting the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) infection. […] The RF model has the best performance, and the RF model predicts the risk of HCC in patients with CHB in the training set [AUC: 0.996, 95% confidence interval (CI) (0.9910.999)] and internal validation set [AUC: 0.993, 95% CI (0.986-1.000)]. […] ML models can be used as a tool to predict the risk of HCC in patients with CHB. […] The RF model has the best predictive performance and helps clinicians to identify high-risk patients and intervene early to reduce or delay the occurrence of HCC. […] Therefore, early and accurate prediction of the risk of HCC in HBV-infected individuals is urgently needed.
#1 Frontiers | Machine learning-based predictive and risk analysis using real-world data with blood biomarkers for hepatitis B patients in the malignant progression of hepatocellular carcinoma
https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.1031400/full
Our study shows the potential of offering a comprehensive understanding of HBV progression via predictive analysis and identifies the most indicative blood biomarkers, which may serve as biomarkers that can be used for immunotherapy. […] Our study shows the potential of offering a comprehensive understanding of HBV progression via predictive analysis.
#1
https://www.xiahepublishing.com/2472-0712/ERHM-2021-00066
The diagnosis of severe acute flares of chronic hepatitis B is guided by raised alanine aminotransferase enzyme levels almost five times the upper limit of normal during the chronic phase of hepatitis B virus (HBV) infection preceded by elevated levels of hepatitis B surface antigen and hepatitis B virus deoxyribonucleic acid (HBV DNA). […] Bridging hepatic necrosis associated with alpha-fetoprotein levels 100 ng/mL or decreasing HBV DNA levels during acute flares are pathognomics of better immune clearance of HBV that eventually progresses to seroclearance. […] Severe or repeated acute flares might progress to hepatic decompensation and liver cirrhosis. Therefore, it is important to prevent acute hepatitis B flares with the appropriate administration of antiviral drug therapy. […] In the CHB-AF group, aspartate (AST) and ALT enzyme levels, platelet count, bilirubin levels, and anti-core antibody (IgM anti-HBc) levels were lower ( The underlying severity of pre-existing liver disease remains the common risk factor for severe AHB flares during CHB infection. […] Serum bilirubin and prothrombin activities are significant predictors of clinical outcomes in patients with severe acute flares or exacerbation of CHB. […] A study conducted in Hong Kong (N=46) in CHB with acute flare patients with no cases of hepatic encephalopathy revealed that 24% of patients died or received liver transplantation during hospital admission. […] Such patients should be monitored regularly once or twice a week for serum ALT enzymes and bilirubin levels, and for prothrombin time measurements to detect clinical deterioration or hepatic decompensation in time for immediate antiviral therapy for prevention or rescue. […] The definitive treatment for severe AFOCHB with acute-on-chronic liver failure (ACLF) is liver transplantation with 5-year survival 90%. Increases in the levels of aminotransferase enzymes is an indicator of immune-mediated hepatocytolysis activity that is associated with increased clearance of HBV. Patients with ALT levels twofive times the ULN with less spontaneous HBV clearance need to be started on anti-HBV drug therapy to prevent the occurrence of hepatitis B flares and related complications.
#1
https://www.xiahepublishing.com/2472-0712/ERHM-2021-00066
The underlying severity of pre-existing liver disease remains the common risk factor for severe AHB flares during CHB infection. […] Serum bilirubin and prothrombin activities are significant predictors of clinical outcomes in patients with severe acute flares or exacerbation of CHB. […] A study conducted in Hong Kong (N=46) in CHB with acute flare patients with no cases of hepatic encephalopathy revealed that 24% of patients died or received liver transplantation during hospital admission. […] Such patients should be monitored regularly once or twice a week for serum ALT enzymes and bilirubin levels, and for prothrombin time measurements to detect clinical deterioration or hepatic decompensation in time for immediate antiviral therapy for prevention or rescue. […] The definitive treatment for severe AFOCHB with acute-on-chronic liver failure (ACLF) is liver transplantation with 5-year survival 90%.
#1
https://www.xiahepublishing.com/2472-0712/ERHM-2021-00066
Increases in the levels of aminotransferase enzymes is an indicator of immune-mediated hepatocytolysis activity that is associated with increased clearance of HBV. Patients with ALT levels twofive times the ULN with less spontaneous HBV clearance need to be started on anti-HBV drug therapy to prevent the occurrence of hepatitis B flares and related complications.
#1 Frontiers | Machine learning-based predictive and risk analysis using real-world data with blood biomarkers for hepatitis B patients in the malignant progression of hepatocellular carcinoma
https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.1031400/full
Hepatitis B Virus (HBV) infection may lead to various liver diseases such as cirrhosis, end-stage liver complications, and Hepatocellular carcinoma (HCC). Patients with existing cirrhosis or severe fibrosis have an increased chance of developing HCC. Consequently, lifetime observation is currently advised. […] Most HCC is asymptomatic in its early stages, and most patients are locally advanced or have distant metastases by the time of diagnosis. The main reason for the low long-term survival rate of liver cancer is, first of all, the imperfect risk assessment of early stage of liver cancer, which leads to 70% to 80% of patients being in the middle to late stage at the time of diagnosis. […] The key to an effective liver cancer surveillance program that provides early diagnosis and improves prognosis is to have simple and accurate tools to identify patients with different liver cancer risks, reduce patient burden, and optimize resource allocation to increase the frequency of surveillance in high-risk groups. Ultimately, individualized patient monitoring of liver cancer risk can be achieved, thereby improving early diagnosis and treatment of liver cancer and ultimately reducing mortality.
#2 Early prediction model for prognosis of patients with hepatitis-B-virus-related acute-on-chronic liver failure received glucocorticoid therapy | European Journal of Medical Research | Full Text
https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-022-00891-w
Early prediction for short-term prognosis is essential for the management of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). […] We proposed a HITAS score, which was an early prediction model for the prognosis of HBVACLF. It might be used to identify HBVACLF patients with favorable responses to glucocorticoid treatment. […] The HITAS score was constructed by five independent predictors: HE grade, INR, TBIL, age and SIRS status. It showed significantly better predictive value than the MELD score and CTP score. Using the cutoff points of 2.5 and 3.47, the HITAS score identified patients that have low, intermediate, and high risks of death. Therefore, it might be used to identify HBVACLF patients with favorable responses to glucocorticoid treatment. […] In conclusion, we constructed a non-invasive model to predict the 90-day mortality in patients with HBVACLF received glucocorticoid treatment. It can stratify the risks of death in patients with HBVACLF and might be used to identify HBVACLF patients with favorable responses to glucocorticoid treatment.
#2 A novel dynamic model for predicting outcome in patients with hepatitis B virus related acute-on-chronic liver failure | Oncotarget
https://www.oncotarget.com/article/22447/text/
Aim: It is challenging to predict the outcome of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) through existing prognostic models. Our aim was to establish a novel dynamic model to improve the predictive efficiency of 30-day mortality in HBV-ACLF patients. […] The HBV-ACLFD model can accurately predict 30-day mortality in patients with HBV-ACLF, which is helpful to select appropriate clinical procedures, so as to relieve the social and economic burden. […] The performance of the HBV-ACLFD model appeared to be superior to MELD score, MELD-Na score and CTP score (P0.0001). […] The results of our research showed that the HBV-ACLFD model exhibited excellent discrimination and almost the same performance in two cohorts (AUROC 0.848 in the derivation cohort and 0.813 in the validation cohort).
#2 A novel dynamic model for predicting outcome in patients with hepatitis B virus related acute-on-chronic liver failure | Oncotarget
https://www.oncotarget.com/article/22447/text/
It is indicated that the HBV-ACLFD model can accurately predict 30-day mortality in patients with HBV-ACLF, which is helpful to select appropriate clinical procedures for HBV-ACLF patients, so as to relieve the social and economic burden. […] The mortality rates in validation cohorts and derivation cohort with HBV-ACLF at 30-day after diagnosis were 25.59% and 35.11%, respectively, which are consistent with the results reported by Xia et al. […] The HBV-ACLFD model showed good discrimination in the derivation cohort. When applied to the separate validation cohort of patients with HBV-ACLF, the new model retained good discrimination, accurately distinguishing the ACLF patients who need LT, and grasping the best opportunity for their transplantation. […] Thus, the HBV-ACLFD model showed good discrimination in the derivation cohort. When applied to the separate validation cohort of patients with HBV-ACLF, the new model retained good discrimination, accurately distinguishing the ACLF patients who need LT, and grasping the best opportunity for their transplantation.
#2
https://journals.lww.com/cmj/fulltext/2012/07010/comparison_of_four_prognostic_models_and_a_new.6.aspx
MELD score at the end of 2 weeks of admission is a useful predictor for 3-month mortality in ACLF-HBV patients. Hepatic encephalopathy, serum creatinine, international normalized ratio, and total bilirubin at the end of 2 weeks of admission and cholinesterase on admission are independent predictors of 3-month mortality. […] The MELD score at the end of 2 weeks of treatment effectively classified patients with ACLF-HBV according to their risk of 3-month mortality, as demonstrated by the high c-statistics (0.8). […] In conclusion, the MELD score at the end of 2 weeks of treatment is a reliable scoring system to predict the 3-month mortality in patients with ACLF-HBV. Similarly, MESO, iMELD and MELD-Na scores at the end of 2 weeks of treatment, and MELD and MESO scores showed good predictive potential for 3-month mortality. […] We also established a logistic regression model that integrates the serum creatinine, INR and total bilirubin at the end of 2 weeks of treatment, hepatic encephalopathy and cholinesterase on admission, and further improves the predictive accuracy.
#2 A roadmap for serum biomarkers for hepatitis B virus: current status and future outlook | Nature Reviews Gastroenterology & Hepatology
https://www.nature.com/articles/s41575-022-00649-z
Hepatitis B core-related antigen levels predict progression to liver cirrhosis in hepatitis B carriers. […] High level of hepatitis B core-related antigen associated with increased risk of hepatocellular carcinoma in patients with chronic HBV infection of intermediate viral load. […] Serum hepatitis B virus RNA levels as an early predictor of hepatitis B envelope antigen seroconversion during treatment with polymerase inhibitors. […] On-treatment low serum HBV RNA level predicts initial virological response in chronic hepatitis B patients receiving nucleoside analogue therapy.
#2 Treatment Response and Long-Term Prognosis Predicted by HBV pgRNA Status – Infectious Disease Advisor
https://www.infectiousdiseaseadvisor.com/news/treatment-response-and-long-term-prognosis-predicted-by-hbv-pgrna-status/
Hepatitis B virus (HBV) DNA replication was suppressed and liver inflammation improved in patients with chronic HBV who were treated with long-term nucleos(t)ide analogue (NA) therapy: After 1 year of NA treatment, patients who were HBV pregenomic RNA (pgRNA)-positive required more time to achieve an undetectable HBV DNA load and hepatitis B e antigen (HBeAg) clearance than patients who were HBV pgRNA-negative, according to a study published in the Journal of Viral Hepatitis. […] After treatment, HBV pgRNA status was significantly different between participants who did achieve HBeAg clearance compared with those who did not (=78), and the logistic regression model showed an association between HBV pgRNA positivity and an increased risk of not clearing HBeAg (hazard ratio, 6.69; 95% CI, 1.88-23.84). […] Patients who were HBV pgRNA-positive after NA treatment were less likely to achieve HBeAg clearance and needed more time to achieve HBeAg clearance and an undetectable HBV DNA load than those who were HBV pgRNA-negative after 1 year of NA treatment.
#2 Development and validation of an interpretable machine learning model for predicting the risk of hepatocellular carcinoma in patients with chronic hepatitis B: a case-control study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03697-2
The aim of this study was to develop and internally validate an interpretable machine learning (ML) model for predicting the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) infection. […] The RF model has the best performance, and the RF model predicts the risk of HCC in patients with CHB in the training set [AUC: 0.996, 95% confidence interval (CI) (0.9910.999)] and internal validation set [AUC: 0.993, 95% CI (0.986-1.000)]. […] ML models can be used as a tool to predict the risk of HCC in patients with CHB. […] The RF model has the best predictive performance and helps clinicians to identify high-risk patients and intervene early to reduce or delay the occurrence of HCC. […] Therefore, early and accurate prediction of the risk of HCC in HBV-infected individuals is urgently needed.
#2 Factors predicting occurrence and prognosis of hepatitis-B-virus-related hepatocellular carcinoma
https://wjgnet.com/1007-9327/full/v17/i38/4258.htm
Imbalance between intratumoral CD8+ T cells and regulatory T cells or Th1 and Th2 cytokines in peritumoral tissues can predict prognosis of HBV-related HCC. […] These factors are important for developing active prevention and surveillance of HBV-infected subjects who are more likely to develop HCC, or for tailoring suitable treatment to improve survival or postpone postoperative recurrence of HCC. […] High viral load is the most reliable factor in predicting poor prognosis of the patients with HBV-related HCC, therefore, antiviral treatment after surgical resection is highly recommended. […] Genotype C was a risk factor independently associated with poor prognosis. […] High serum level of IL-6 predicts future occurrence of HCC in patients with CHB.
#2 Frontiers | Machine learning-based predictive and risk analysis using real-world data with blood biomarkers for hepatitis B patients in the malignant progression of hepatocellular carcinoma
https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2022.1031400/full
Hepatitis B Virus (HBV) infection may lead to various liver diseases such as cirrhosis, end-stage liver complications, and Hepatocellular carcinoma (HCC). Patients with existing cirrhosis or severe fibrosis have an increased chance of developing HCC. Consequently, lifetime observation is currently advised. […] Most HCC is asymptomatic in its early stages, and most patients are locally advanced or have distant metastases by the time of diagnosis. The main reason for the low long-term survival rate of liver cancer is, first of all, the imperfect risk assessment of early stage of liver cancer, which leads to 70% to 80% of patients being in the middle to late stage at the time of diagnosis. […] The key to an effective liver cancer surveillance program that provides early diagnosis and improves prognosis is to have simple and accurate tools to identify patients with different liver cancer risks, reduce patient burden, and optimize resource allocation to increase the frequency of surveillance in high-risk groups. Ultimately, individualized patient monitoring of liver cancer risk can be achieved, thereby improving early diagnosis and treatment of liver cancer and ultimately reducing mortality.
#3 Early prediction model for prognosis of patients with hepatitis-B-virus-related acute-on-chronic liver failure received glucocorticoid therapy | European Journal of Medical Research | Full Text
https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-022-00891-w
Early prediction for short-term prognosis is essential for the management of hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). […] We proposed a HITAS score, which was an early prediction model for the prognosis of HBVACLF. It might be used to identify HBVACLF patients with favorable responses to glucocorticoid treatment. […] The HITAS score was constructed by five independent predictors: HE grade, INR, TBIL, age and SIRS status. It showed significantly better predictive value than the MELD score and CTP score. Using the cutoff points of 2.5 and 3.47, the HITAS score identified patients that have low, intermediate, and high risks of death. Therefore, it might be used to identify HBVACLF patients with favorable responses to glucocorticoid treatment. […] In conclusion, we constructed a non-invasive model to predict the 90-day mortality in patients with HBVACLF received glucocorticoid treatment. It can stratify the risks of death in patients with HBVACLF and might be used to identify HBVACLF patients with favorable responses to glucocorticoid treatment.
#4 A novel dynamic model for predicting outcome in patients with hepatitis B virus related acute-on-chronic liver failure | Oncotarget
https://www.oncotarget.com/article/22447/text/
Aim: It is challenging to predict the outcome of patients with hepatitis B virus related acute-on-chronic liver failure (HBV-ACLF) through existing prognostic models. Our aim was to establish a novel dynamic model to improve the predictive efficiency of 30-day mortality in HBV-ACLF patients. […] The HBV-ACLFD model can accurately predict 30-day mortality in patients with HBV-ACLF, which is helpful to select appropriate clinical procedures, so as to relieve the social and economic burden. […] The performance of the HBV-ACLFD model appeared to be superior to MELD score, MELD-Na score and CTP score (P0.0001). […] The results of our research showed that the HBV-ACLFD model exhibited excellent discrimination and almost the same performance in two cohorts (AUROC 0.848 in the derivation cohort and 0.813 in the validation cohort).
#5 A novel dynamic model for predicting outcome in patients with hepatitis B virus related acute-on-chronic liver failure | Oncotarget
https://www.oncotarget.com/article/22447/text/
It is indicated that the HBV-ACLFD model can accurately predict 30-day mortality in patients with HBV-ACLF, which is helpful to select appropriate clinical procedures for HBV-ACLF patients, so as to relieve the social and economic burden. […] The mortality rates in validation cohorts and derivation cohort with HBV-ACLF at 30-day after diagnosis were 25.59% and 35.11%, respectively, which are consistent with the results reported by Xia et al. […] The HBV-ACLFD model showed good discrimination in the derivation cohort. When applied to the separate validation cohort of patients with HBV-ACLF, the new model retained good discrimination, accurately distinguishing the ACLF patients who need LT, and grasping the best opportunity for their transplantation. […] Thus, the HBV-ACLFD model showed good discrimination in the derivation cohort. When applied to the separate validation cohort of patients with HBV-ACLF, the new model retained good discrimination, accurately distinguishing the ACLF patients who need LT, and grasping the best opportunity for their transplantation.
#6 Noninvasive models for predicting poor prognosis of chronic HBV infection patients precipitating acute HEV infection | Scientific Reports
https://www.nature.com/articles/s41598-020-59670-4
Hepatitis E virus (HEV) infection contributes to a considerable proportion of acute-on-chronic liver failure (ACLF) in patients with chronic hepatitis B virus (HBV) infection. This study aimed to predict the prognosis of chronic HBV infection patients precipitating acute HEV infection. […] For predicting the poor prognosis of ACLF patients, the COSSH-ACLFs yielded a significantly higher AUROC compared with CLIF-C ACLFs, CLIF-C OFs, MELD score, and CTP score (0.89, 0.83, 0.81, 0.67, and 0.58, respectively; all p<0.05). [...] In conclusion, the stepwise application of CTP score and COSSH-ACLFs can predict the prognosis of chronic HBV infection patients precipitating acute HEV infection. [...] The CTP score is the best model for predicting the development of ACLF in chronic HBV infection patients precipitating acute HEV infection. The COSSH-ACLFs is the best model for predicting the poor outcome of ACLF patients. The CTP-COSSH-ACLFs algorithm, which sequentially combines CTP-score and COSSH-ACLFs, can discriminate patients at low risk of developing ACLF with excellent prognosis from those at high risk of developing ACLF with impaired prognosis and need specialized care.
#7 Development and validation of an interpretable machine learning model for predicting the risk of hepatocellular carcinoma in patients with chronic hepatitis B: a case-control study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03697-2
The aim of this study was to develop and internally validate an interpretable machine learning (ML) model for predicting the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB) infection. […] The RF model has the best performance, and the RF model predicts the risk of HCC in patients with CHB in the training set [AUC: 0.996, 95% confidence interval (CI) (0.9910.999)] and internal validation set [AUC: 0.993, 95% CI (0.986-1.000)]. […] ML models can be used as a tool to predict the risk of HCC in patients with CHB. […] The RF model has the best predictive performance and helps clinicians to identify high-risk patients and intervene early to reduce or delay the occurrence of HCC. […] Therefore, early and accurate prediction of the risk of HCC in HBV-infected individuals is urgently needed.
#8 Development and validation of an interpretable machine learning model for predicting the risk of hepatocellular carcinoma in patients with chronic hepatitis B: a case-control study | BMC Gastroenterology | Full Text
https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03697-2
The present study aimed to develop and validate an interpretable ML model for predicting the risk of HCC in patients with CHB. […] The main outcome index of this study was whether the patient had HBV-related HCC. […] Five predictive models were developed and internally validated using ML algorithms to assess the risk of HCC in patients with CHB. […] The results show that the RF model outperforms the ANN in terms of sensitivity, specificity and AUC, indicating that the RF model is more robust in processing limited sample size and high noise data. […] The results of this study showed that age was one of the most important risk factors for HCC. […] Therefore, increased age, BLR, D-Dimer, AST/ALT, GGT, and AFP were important predictors of the risk of HCC in CHB patients. […] We identified age, BLR, D-Dimer, AST/ALT, GGT, and AFP as predictors of HCC risk in CHB patients and constructed and validated an interpretable ML model to assess the risk of HCC in CHB patients.