Validation of TPPM Score in predicting short-term survival in HBV-ACLF patients: a multi-national study from APASL ACLF Research Consortium (AARC)

Abstract

Objective: Tongji prognostic predictor model (TPPM)for HBV‐ ACLF, includes bilirubin (TBIL), INR, number of complications and HBV DNA and has been validated for its predictive value from a single center. We aimed to compare TPPM model with model of end‐stage liver disease (MELD) and MELD‐Na in predicting short term survival in patients with HBV‐ACLF from APASL ACLF Research Consortium (AARC) data base, from 26 countries. Patients and Methods: In this prospective‐retrospective study, we enrolled 471 (302 males) patients with HBV‐ACLF who were hospitalized and treated with anti‐HBV nucleot(s)ide analogues (NUCs) and traditional internal medicines. TPPM, MELD and MELD‐Na score were measured at hospitalization and 90‐day survival was predicted. Results: Among the 471enrolled patients, 302 (64.1%) survived and 169 (35.9%) were non‐survivors at 90‐day The baseline characters including age (44.59±13.62 vs. 45.73±14.86yr), gender (male/female, 208/263 vs. 141/161), ALT (491±830vs. 566±773IU/ml), AST (566±723 vs. 602±864, lU/ml), TBIL (18.2±9.1 vs. 21.7±9.5, mg/dl) and INR (2.07±0.69 vs. 2.65±1.27)did not show significant difference (p > 0.05) between survivors and non‐survivors The baseline prognostic scores of TPPM, MELD and MELD‐Na between survivors and non‐survivors were 0.87±0.15 vs. 0.79±0.22 (p<0.001), 24.52±5.69 vs. 29.16±6.57 (p=0.013) and 27.27±5.67vs. 31,62±5.37 (p=0.043). Using the Hosmer‐Lemeshow test, the validation of the TPPM score for HBV‐ACLF demonstrated a good degree of fit with prediction of disease prognosis. Based on this large cohort of patients, the TPPM score with an AUC of 0.732 was found superior to the MELD score and MELD‐Na score, which had an AUC of 0.712 and 0.714 in predicting 90‐day mortality in HBV‐ACLF. Conclusion: The TPPM scoring system has been found to be truly predictive and has been validated in the international AARC database. It shows its superiority in a disease specific scenario of HBV ACLF compared with MELD and MELD‐Na, and is recommended for patient stratification at admission for NUCs and/or liver transplantation.