A Model to Predict 1-Month Risk of Transplant or Death in Hepatitis A–Related Acute Liver Failure

Jin Dong Kim, Eun Ju Cho, Choonghyun Ahn, Sue K. Park, Jong Young Choi, Han Chu Lee, Do Young Kim, Moon Seok Choi, Hee Jung Wang, In Hee Kim, Jong Eun Yeon, Yeon Seok Seo, Won Young Tak, Moon Young Kim, Heon Ju Lee, Yun Soo Kim, Dae Won Jun, Joo Hyun Sohn, So Young Kwon, Sang Hoon ParkJeong Heo, Sook Hyang Jeong, Jeong Hoon Lee, Nobuaki Nakayama, Satoshi Mochida, Akio Ido, Hirohito Tsubouchi, Hazime Takikawa, Shalimar, Subrat Kumar Acharya, William Bernal, John O’Grady, Yoon Jun Kim

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Abstract

Acute liver failure (ALF) caused by hepatitis A is a rare but fatal disease. Here, we developed a model to predict outcome in patients with ALF caused by hepatitis A. The derivation set consisted of 294 patients diagnosed with hepatitis A–related ALF (ALFA) from Korea, and a validation set of 56 patients from Japan, India, and United Kingdom. Using a multivariate proportional hazard model, a risk-prediction model (ALFA score) consisting of age, international normalized ratio, bilirubin, ammonia, creatinine, and hemoglobin levels acquired on the day of ALF diagnosis was developed. The ALFA score showed the highest discrimination in the prediction of liver transplant or death at 1 month (c-statistic, 0.87; 95% confidence interval [CI], 0.84-0.92) versus King’s College criteria (KCC; c-statistic, 0.56; 95% CI, 0.53-0.59), U.S. Acute Liver Failure Study Group index specific for hepatitis A virus (HAV-ALFSG; c-statistic, 0.70; 95% CI, 0.65-0.76), the new ALFSG index (c-statistic, 0.79; 95% CI, 0.74-0.84), Model for End-Stage Liver Disease (MELD; c-statistic, 0.79; 95% CI, 0.74-0.84), and MELD including sodium (MELD-Na; c-statistic, 0.78; 95% CI, 0.73-0.84) in the derivation set (all P < 0.01). In the validation set, the performance of the ALFA score (c-statistic, 0.84; 95% CI, 0.74-0.94) was significantly better than that of KCC (c-statistic, 0.65; 95% CI, 0.52-0.79), MELD (c-statistic, 0.74; 95% CI, 0.61-0.87), and MELD-Na (c-statistic, 0.72; 95% CI, 0.58-0.85) (all P < 0.05), and better, but not statistically significant, than that of the HAV-ALFSG (c-statistic, 0.76; 95% CI, 0.61-0.90; P = 0.28) and new ALFSG indices (c-statistic, 0.79; 95% CI, 0.65-0.93; P = 0.41). The model was well-calibrated in both sets. Conclusion: Our disease-specific score provides refined prediction of outcome in patients with ALF caused by hepatitis A.

Original languageEnglish
JournalHepatology
DOIs
Publication statusPublished - 2019 Jan 1

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Acute Liver Failure
Hepatitis
Confidence Intervals
Transplants
Hepatitis A
Hepatitis A virus
End Stage Liver Disease
International Normalized Ratio
Korea
Rare Diseases
Bilirubin
Ammonia
Proportional Hazards Models
India
Creatinine
Japan
Hemoglobins
Sodium

ASJC Scopus subject areas

  • Hepatology

Cite this

Kim, J. D., Cho, E. J., Ahn, C., Park, S. K., Choi, J. Y., Lee, H. C., ... Kim, Y. J. (2019). A Model to Predict 1-Month Risk of Transplant or Death in Hepatitis A–Related Acute Liver Failure. Hepatology. https://doi.org/10.1002/hep.30262

A Model to Predict 1-Month Risk of Transplant or Death in Hepatitis A–Related Acute Liver Failure. / Kim, Jin Dong; Cho, Eun Ju; Ahn, Choonghyun; Park, Sue K.; Choi, Jong Young; Lee, Han Chu; Kim, Do Young; Choi, Moon Seok; Wang, Hee Jung; Kim, In Hee; Yeon, Jong Eun; Seo, Yeon Seok; Tak, Won Young; Kim, Moon Young; Lee, Heon Ju; Kim, Yun Soo; Jun, Dae Won; Sohn, Joo Hyun; Kwon, So Young; Park, Sang Hoon; Heo, Jeong; Jeong, Sook Hyang; Lee, Jeong Hoon; Nakayama, Nobuaki; Mochida, Satoshi; Ido, Akio; Tsubouchi, Hirohito; Takikawa, Hazime; Shalimar; Acharya, Subrat Kumar; Bernal, William; O’Grady, John; Kim, Yoon Jun.

In: Hepatology, 01.01.2019.

Research output: Contribution to journalArticle

Kim, JD, Cho, EJ, Ahn, C, Park, SK, Choi, JY, Lee, HC, Kim, DY, Choi, MS, Wang, HJ, Kim, IH, Yeon, JE, Seo, YS, Tak, WY, Kim, MY, Lee, HJ, Kim, YS, Jun, DW, Sohn, JH, Kwon, SY, Park, SH, Heo, J, Jeong, SH, Lee, JH, Nakayama, N, Mochida, S, Ido, A, Tsubouchi, H, Takikawa, H, Shalimar, Acharya, SK, Bernal, W, O’Grady, J & Kim, YJ 2019, 'A Model to Predict 1-Month Risk of Transplant or Death in Hepatitis A–Related Acute Liver Failure', Hepatology. https://doi.org/10.1002/hep.30262
Kim, Jin Dong ; Cho, Eun Ju ; Ahn, Choonghyun ; Park, Sue K. ; Choi, Jong Young ; Lee, Han Chu ; Kim, Do Young ; Choi, Moon Seok ; Wang, Hee Jung ; Kim, In Hee ; Yeon, Jong Eun ; Seo, Yeon Seok ; Tak, Won Young ; Kim, Moon Young ; Lee, Heon Ju ; Kim, Yun Soo ; Jun, Dae Won ; Sohn, Joo Hyun ; Kwon, So Young ; Park, Sang Hoon ; Heo, Jeong ; Jeong, Sook Hyang ; Lee, Jeong Hoon ; Nakayama, Nobuaki ; Mochida, Satoshi ; Ido, Akio ; Tsubouchi, Hirohito ; Takikawa, Hazime ; Shalimar ; Acharya, Subrat Kumar ; Bernal, William ; O’Grady, John ; Kim, Yoon Jun. / A Model to Predict 1-Month Risk of Transplant or Death in Hepatitis A–Related Acute Liver Failure. In: Hepatology. 2019.
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abstract = "Acute liver failure (ALF) caused by hepatitis A is a rare but fatal disease. Here, we developed a model to predict outcome in patients with ALF caused by hepatitis A. The derivation set consisted of 294 patients diagnosed with hepatitis A–related ALF (ALFA) from Korea, and a validation set of 56 patients from Japan, India, and United Kingdom. Using a multivariate proportional hazard model, a risk-prediction model (ALFA score) consisting of age, international normalized ratio, bilirubin, ammonia, creatinine, and hemoglobin levels acquired on the day of ALF diagnosis was developed. The ALFA score showed the highest discrimination in the prediction of liver transplant or death at 1 month (c-statistic, 0.87; 95{\%} confidence interval [CI], 0.84-0.92) versus King’s College criteria (KCC; c-statistic, 0.56; 95{\%} CI, 0.53-0.59), U.S. Acute Liver Failure Study Group index specific for hepatitis A virus (HAV-ALFSG; c-statistic, 0.70; 95{\%} CI, 0.65-0.76), the new ALFSG index (c-statistic, 0.79; 95{\%} CI, 0.74-0.84), Model for End-Stage Liver Disease (MELD; c-statistic, 0.79; 95{\%} CI, 0.74-0.84), and MELD including sodium (MELD-Na; c-statistic, 0.78; 95{\%} CI, 0.73-0.84) in the derivation set (all P < 0.01). In the validation set, the performance of the ALFA score (c-statistic, 0.84; 95{\%} CI, 0.74-0.94) was significantly better than that of KCC (c-statistic, 0.65; 95{\%} CI, 0.52-0.79), MELD (c-statistic, 0.74; 95{\%} CI, 0.61-0.87), and MELD-Na (c-statistic, 0.72; 95{\%} CI, 0.58-0.85) (all P < 0.05), and better, but not statistically significant, than that of the HAV-ALFSG (c-statistic, 0.76; 95{\%} CI, 0.61-0.90; P = 0.28) and new ALFSG indices (c-statistic, 0.79; 95{\%} CI, 0.65-0.93; P = 0.41). The model was well-calibrated in both sets. Conclusion: Our disease-specific score provides refined prediction of outcome in patients with ALF caused by hepatitis A.",
author = "Kim, {Jin Dong} and Cho, {Eun Ju} and Choonghyun Ahn and Park, {Sue K.} and Choi, {Jong Young} and Lee, {Han Chu} and Kim, {Do Young} and Choi, {Moon Seok} and Wang, {Hee Jung} and Kim, {In Hee} and Yeon, {Jong Eun} and Seo, {Yeon Seok} and Tak, {Won Young} and Kim, {Moon Young} and Lee, {Heon Ju} and Kim, {Yun Soo} and Jun, {Dae Won} and Sohn, {Joo Hyun} and Kwon, {So Young} and Park, {Sang Hoon} and Jeong Heo and Jeong, {Sook Hyang} and Lee, {Jeong Hoon} and Nobuaki Nakayama and Satoshi Mochida and Akio Ido and Hirohito Tsubouchi and Hazime Takikawa and Shalimar and Acharya, {Subrat Kumar} and William Bernal and John O’Grady and Kim, {Yoon Jun}",
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T1 - A Model to Predict 1-Month Risk of Transplant or Death in Hepatitis A–Related Acute Liver Failure

AU - Kim, Jin Dong

AU - Cho, Eun Ju

AU - Ahn, Choonghyun

AU - Park, Sue K.

AU - Choi, Jong Young

AU - Lee, Han Chu

AU - Kim, Do Young

AU - Choi, Moon Seok

AU - Wang, Hee Jung

AU - Kim, In Hee

AU - Yeon, Jong Eun

AU - Seo, Yeon Seok

AU - Tak, Won Young

AU - Kim, Moon Young

AU - Lee, Heon Ju

AU - Kim, Yun Soo

AU - Jun, Dae Won

AU - Sohn, Joo Hyun

AU - Kwon, So Young

AU - Park, Sang Hoon

AU - Heo, Jeong

AU - Jeong, Sook Hyang

AU - Lee, Jeong Hoon

AU - Nakayama, Nobuaki

AU - Mochida, Satoshi

AU - Ido, Akio

AU - Tsubouchi, Hirohito

AU - Takikawa, Hazime

AU - Shalimar,

AU - Acharya, Subrat Kumar

AU - Bernal, William

AU - O’Grady, John

AU - Kim, Yoon Jun

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Acute liver failure (ALF) caused by hepatitis A is a rare but fatal disease. Here, we developed a model to predict outcome in patients with ALF caused by hepatitis A. The derivation set consisted of 294 patients diagnosed with hepatitis A–related ALF (ALFA) from Korea, and a validation set of 56 patients from Japan, India, and United Kingdom. Using a multivariate proportional hazard model, a risk-prediction model (ALFA score) consisting of age, international normalized ratio, bilirubin, ammonia, creatinine, and hemoglobin levels acquired on the day of ALF diagnosis was developed. The ALFA score showed the highest discrimination in the prediction of liver transplant or death at 1 month (c-statistic, 0.87; 95% confidence interval [CI], 0.84-0.92) versus King’s College criteria (KCC; c-statistic, 0.56; 95% CI, 0.53-0.59), U.S. Acute Liver Failure Study Group index specific for hepatitis A virus (HAV-ALFSG; c-statistic, 0.70; 95% CI, 0.65-0.76), the new ALFSG index (c-statistic, 0.79; 95% CI, 0.74-0.84), Model for End-Stage Liver Disease (MELD; c-statistic, 0.79; 95% CI, 0.74-0.84), and MELD including sodium (MELD-Na; c-statistic, 0.78; 95% CI, 0.73-0.84) in the derivation set (all P < 0.01). In the validation set, the performance of the ALFA score (c-statistic, 0.84; 95% CI, 0.74-0.94) was significantly better than that of KCC (c-statistic, 0.65; 95% CI, 0.52-0.79), MELD (c-statistic, 0.74; 95% CI, 0.61-0.87), and MELD-Na (c-statistic, 0.72; 95% CI, 0.58-0.85) (all P < 0.05), and better, but not statistically significant, than that of the HAV-ALFSG (c-statistic, 0.76; 95% CI, 0.61-0.90; P = 0.28) and new ALFSG indices (c-statistic, 0.79; 95% CI, 0.65-0.93; P = 0.41). The model was well-calibrated in both sets. Conclusion: Our disease-specific score provides refined prediction of outcome in patients with ALF caused by hepatitis A.

AB - Acute liver failure (ALF) caused by hepatitis A is a rare but fatal disease. Here, we developed a model to predict outcome in patients with ALF caused by hepatitis A. The derivation set consisted of 294 patients diagnosed with hepatitis A–related ALF (ALFA) from Korea, and a validation set of 56 patients from Japan, India, and United Kingdom. Using a multivariate proportional hazard model, a risk-prediction model (ALFA score) consisting of age, international normalized ratio, bilirubin, ammonia, creatinine, and hemoglobin levels acquired on the day of ALF diagnosis was developed. The ALFA score showed the highest discrimination in the prediction of liver transplant or death at 1 month (c-statistic, 0.87; 95% confidence interval [CI], 0.84-0.92) versus King’s College criteria (KCC; c-statistic, 0.56; 95% CI, 0.53-0.59), U.S. Acute Liver Failure Study Group index specific for hepatitis A virus (HAV-ALFSG; c-statistic, 0.70; 95% CI, 0.65-0.76), the new ALFSG index (c-statistic, 0.79; 95% CI, 0.74-0.84), Model for End-Stage Liver Disease (MELD; c-statistic, 0.79; 95% CI, 0.74-0.84), and MELD including sodium (MELD-Na; c-statistic, 0.78; 95% CI, 0.73-0.84) in the derivation set (all P < 0.01). In the validation set, the performance of the ALFA score (c-statistic, 0.84; 95% CI, 0.74-0.94) was significantly better than that of KCC (c-statistic, 0.65; 95% CI, 0.52-0.79), MELD (c-statistic, 0.74; 95% CI, 0.61-0.87), and MELD-Na (c-statistic, 0.72; 95% CI, 0.58-0.85) (all P < 0.05), and better, but not statistically significant, than that of the HAV-ALFSG (c-statistic, 0.76; 95% CI, 0.61-0.90; P = 0.28) and new ALFSG indices (c-statistic, 0.79; 95% CI, 0.65-0.93; P = 0.41). The model was well-calibrated in both sets. Conclusion: Our disease-specific score provides refined prediction of outcome in patients with ALF caused by hepatitis A.

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