Development and validation of the nomogram based on ICGR15 and PNR to predict 28-day of mortality in patients with hepatitis B virus-related acute-on-chronic liver failure

Abstract Background: Acute-on-chronic liver failure (ACLF) is a critical disease with a high mortality. Here, we developed and validated a new and simple prognostic nomogram to predict the 28-day mortality in patients with hepatitis B virus-related ACLF (HBV-ACLF). Methods: A 28-day follow-up was conducted on 353 patients with HBV-ACLF to develop this nomogram. Patients were randomly assigned to the training cohort (n=248) and validation cohort (n=105) at 7:3. The nomogram was evaluated using the concordance index (C-index) and calibration curve. We also compared the nomogram with the model for end-stage liver disease (MELD) score, age-bilirubin-international normalized ratio (INR)-creatinine (ABIC) score, and albumin-bilirubin (ALBI) score. Results: Multivariate logistic regression analysis showed that age (p = 0.014), total bilirubin (p = 0.006), INR (p = 0.002), platelet to neutrophil ratio (PNR) (p = 0.004), and indocyanine green retention at 15 min (ICGR15) (p = 0.012) were independent predictors of 28-day mortality in patients with HBV-ACLF. The nomogram was constructed using these risk factors to predict the 28-day mortality rate. The C-indexes of training and testing data were 0.867 and 0.788, respectively, indicating strong consistency between the results on the nomogram and the actual results of internal validation. The calibration curve of the nomogram used to predict the 28-day mortality rate of patients with HBV-ACLF showed high consistency. The area under the receiver-operating characteristics curve (AUC) performance of the nomogram in the training cohort was superior to that of ALBI, ABIC, and MELD, and was comparable to that in the validation cohort. Conclusion: This study emphasizes the predictive value of ICGR15 and PNR, and the nomogram based on ICGR15 and PNR can effectively estimate the individualized risk of short-term death in patients with HBV-ACLF defined by the Asian Pacific Association for the Study of the Liver (APASL).