Validation of TPPM Score in Predicting Short-Term Survival in HBV-ACLF Patients: A Multinational Study from APASL ACLF Research Consortium (AARC)

Abstract

Background: 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. In the present study, we compared TPPM with AARC score, MELDMELD-Na, CLIF-C OF and CLIF-C ACLF in predicting 28 and 90 days mortality in patients with HBV-ACLF. Methods: 606 HBV-ACLF patients defined by the AARC criteria from the AARC database, gathered from 12 Asian-Pacific countries, were enrolled in the study. Patients were stratified by cirrhosis and CLIF-C criteria. The prognostic performance for 28 and 90 days mortality were compared by area under the receiver operating characteristic curves (AUROC). Results: Among total 606 patients, 375 (61.88%) patients had cirrhosis. In the cirrhotic and noncirrhotic patients,150 and 79 patients met CLIF-C criteria respectively. The 28 and 90 days mortality of patients defined by CLIF-C criteria were significantly higher than those who did not satisfy the CLIF-C criteria. As ACLF grades increased, survival rates became significantly lower. Among total patients, AUROC of the TPPM (0.837, 0.780) was higher than MELD (0.755, 0.711), MELD-Na (0.753, 0.723), AARC (0.790, 0.776), CLIF-C OF (0.832, 0.783) and CLIF-C ACLF (0.796, 0.742) in predicting 28 and 90 days mortality respectively. With a cutoff value of 0.28 for 90 days mortality, the TPPM positive and negative predictive values were 52.43% and 85.73% respectively. Among cirrhotic patients, AUROC of the TPPM (0.854, 0.762) was higher than MELD (0.757, 0.697), MELDNa (0.753, 0.709), AARC (0.802, 0.780), CLIF-C OF (0.812, 0.749) and CLIF-C ACLF (0.753, 0.711) in predicting 28 and 90 days mortality respectively. With a cut-off value of 0.28, the TPPM positive and negative prediction values were 56.20% and 83.20% for 90 days mortality respectively. Conclusion: The TPPM scoring system possesses higher predicting ability in HBV-ACLF patients when compared with MELD, MELDNa, AARC, CLIF-C OF and CLIF-C ACLF.