Development and validation of a novel prognostic score for HBV-related acute-on-chronic liver failure.

Background: Acute-on-chronic liver failure patients have high short-term mortality rates, and HBV infection is the most common cause. Current prognostic models for HBV-ACLF patients have limitations. Thus, the development of an ideal model remains an important unsolved problem. Aims: To develop a new model and validate its prognostic predictive capacity. Methods: Among 5854 liver failure patients admitted to the Second Affiliated Hospital of Chongqing Medical University from 2008 to 2023, 1170 HBV-ACLF cases were finally enrolled, which were randomly divided into a development cohort ( Results: The AHF-MELD and AHN-MELD scores' predictive capacity were stronger than MELD, MELD-sodium, CLIF-C OF and AARC scores and comparable to CLIF-C ACLF, COSSH ACLF and COSSH ACLF II scores. There was no significant difference between the observed and the predicted 28-day and 90-day mortality probabilities of new scores. The AHF-MELD and AHN-MELD scores have positive net benefits over a wide range of threshold probabilities and outperform conventional scores. The 28-day and 90-day survival rates were significantly lower in high-risk groups than in low-risk groups. Conclusion: The AHF-MELD and AHN-MELD scores may serve as potential predictive tools for the short-term prognosis of HBV-ACLF patients. Our study may provide useful information for clinicians managing these patients.