Conditional survival estimate of acute-on-chronic hepatitis B liver failure: a dynamic prediction based on a multicenter cohort.

ABSTRACT: Counseling patients with acute-on-chronic hepatitis B liver failure (ACHBLF) on their individual risk of short-term mortality is challenging. This study aimed to develop a conditional survival estimate (CSE) for predicting individualized mortality risk in ACHBLF patients.We performed a large prospective cohort study of 278 ACHBLF patients from December 2010 to December 2013 at three participating medical centers. The Kaplan-Meier method was used to calculate the cumulative overall survival (OS). Cox proportional hazard regression models were used to analyze the risk factors associated with OS. 4-week CSE at "X" week after diagnostic established were calculated as CS4 = OS(X+4)/OS(X).The actual OS at 2, 4, 6, 8, 12 weeks were 80.5%, 71.8%, 69.3%, 66.0% and 63.7%, respectively. Using CSE, the probability of surviving an additional 4 weeks, given that the patient had survived for 1, 3, 5, 7, 9 weeks was 74%, 86%, 92%, 93%, 97%, respectively. Patients with worse prognostic feathers, including MELD > 25, Child grade C, age > 45, HE, INR > 2.5, demonstrated the greatest increase in CSE over time, when compared with the "favorable" one (?36% vs. ?10%; ?28% vs. ?16%; ?29% vs. ?15%; ?60% vs. ?12%; ?33% vs. ?12%; all P < 0.001; respectively).This easy-to-use CSE can accurately predict the changing probability of survival over time. It may facilitate risk communication between patients and physicians.

SUBMITTER: Zheng MH 

PROVIDER: S-EPMC4695116 | biostudies-literature | 2015 Sep

REPOSITORIES: biostudies-literature