2D shear wave elastography combined with MELD improved prognostic accuracy in patients with acute-on-chronic hepatitis B liver failure
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To evaluate accuracy of two-dimensional shear wave elastography (2D SWE) and develop and validate a new prognostic score in predicting prognosis of acute-on-chronic liver failure (ACLF) patients.
From 1 October 2013 to 30 September 2015, we consecutively enrolled 290 patients, sequentially collected data (including 2D SWE, ultrasound parameters, laboratory data and prognostic scores) and recorded patients’ outcome (recovering/steady or worsening) during a 90-day follow-up period. We evaluated ability of 2D SWE to predict outcomes of acute-on-chronic hepatitis B liver failure (ACLF-HBV) patients. We developed a new score (MELD-SWE, combining MELD and SWE values) for predicting mortality risk of ACLF-HBV in 179 patients in a derivation group, and validated in 111 patients.
2D SWE values were higher in worsening patients than recovering/steady ones (p < 0.001). Accuracy of 2D SWE in predicting outcomes of ACLF-HBV was comparable to that of the MELD score (p = 0.441). MELD-SWE showed a significantly higher prognostic value than MELD in both derivation (AUROC, 0.80 vs. 0.76, p = 0.040) and validation (AUROC, 0.87 vs. 0.82, p = 0.018) group.
The MELD-SWE score, combining MELD and SWE values, was superior to MELD alone for outcoming prediction in patients with ACLF-HBV.
• 2D SWE is a simple prognostic evaluation tool in patients with ACLF-HBV.
• MELD-SWE was created in this study: 1.3×MELD + 0.3×2D SWE (kPa).
• MELD-SWE score was superior to MELD alone for outcoming prediction in ACLF-HBV.
• In this study, 46.8 was the optimal cut-off value of MELD-SWE score.
KeywordsAcute-on-chronic liver failure Elastography Prognosis End-stage liver disease Ultrasonography
- 2D SWE
Two-dimensional shear wave elastography
American Association for the Study of Liver Diseases
Acute-on-chronic hepatitis B liver failure
Acute-on-chronic liver failure
Asian Pacific Association for the Study of the Liver
Area under the receiver operating characteristic curve
Chronic Liver Failure Acute-on-Chronic Liver Failure in Cirrhosis
Hepatitis B e antigen
Hepatitis B surface antigen
- HBV DNA
Hepatitis B virus deoxyribonucleic acid
Hepatitis B virus
Intraclass correlation coefficient
International normalized ratio
King’s College Hospital
Liver stiffness measurement
Model for End-stage Liver Disease
Model for End-stage Liver Disease score combined with Sodium
Point shear wave elastography
Region of interest
United Network for Organ Sharing
White blood cell
World Health Organization
This study has received funding by the Science and technology project of Guangdong Province (No. 2014A020212059), the Natural Science Fund of Guangdong province (No. 2015A030313172 and 2016A030313237), the Guangzhou city science and technology project (No. 201607010064).
Compliance with ethical standards
The scientific guarantor of this publication is Rongqin Zheng.
Conflict of interest
The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• performed at one institution
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