Evaluation of the prognosis of hepatitis B virus-associated acute-on-chronic liver failure patients using a combined model for end-stage liver disease score with blood ammonia, lactate dehydrogenase, aspartate aminotransferase, and alanine aminotransferase

Abstract

Hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is a severe clinical syndrome with a high mortality rate. Identifying prognostic factors is therefore crucial. This study aimed to identify factors influencing the prognosis of HBV-ACLF and to construct a combined prognostic indicator. This retrospective study included 258 patients with HBV-ACLF, categorized into 2 groups based on prognosis: improvement and worsening. Baseline characteristics, biochemical parameters, and hematological indicators were compared between the 2 groups. Multiple logistic regression and a support vector machine model were applied to analyze the factors associated with prognosis. Based on the regression results, a composite indicator was developed and its predictive performance was evaluated using receiver operating characteristic curve analysis. The incidence of complications such as advanced age, esophageal varices, severe jaundice, and severe ascites was significantly higher in the prognosis worsening group than in the improvement group. Biochemical and hematological indicators such as ammonia (NH₃), lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were significantly elevated in the worsening group, while albumin levels were significantly lower compared with the improvement group. Analysis indicated that ALT, AST, LDH, NH₃, and model for end-stage liver disease score were most strongly associated with prognosis. The receiver operating characteristic curve of the combined indicator showed an area under the curve of 0.749, outperforming any single indicator. In addition, the combined index was significantly negatively correlated with the length of hospital stay. ALT, AST, LDH, NH₃, and model for end-stage liver disease score are key prognostic factors in patients with HBV-ACLF. The combined indicator constructed from these variables demonstrates good predictive value for clinical outcomes and length of hospital stay, and may provide useful guidance for clinical decision-making.

Keywords: hepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF); prognostic evaluation; support vector machine (SVM).