ALTA: a simple nutritional prognostic score for patients with hepatitis B virus-related acute-on-chronic liver failure

Rui Song; Xiaohao Wang; Zhao Li; Hongyu Wu; Jiahe Tan; Junyi Tan; Hanlu Li; Teng Zeng; Hong Ren; Zhiwei Chen

doi:10.3389/fnut.2024.1370025

ALTA: a simple nutritional prognostic score for patients with hepatitis B virus-related acute-on-chronic liver failure

Front Nutr. 2024 Apr 9:11:1370025. doi: 10.3389/fnut.2024.1370025. eCollection 2024.

Authors

Rui Song^#¹, Xiaohao Wang^#¹, Zhao Li^#², Hongyu Wu^#³, Jiahe Tan⁴, Junyi Tan⁵, Hanlu Li⁵, Teng Zeng⁶, Hong Ren¹, Zhiwei Chen¹

Affiliations

¹ Key Laboratory of Molecular Biology for Infectious Diseases, Department of Infectious Diseases, Institute for Viral Hepatitis, The Second Affiliated Hospital of Chongqing Medical University, Chinese Ministry of Education, Chongqing, China.
² Department of Gastroenterology, The Seventh People's Hospital of Chongqing, Chongqing, China.
³ Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁴ Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁵ Department of Infectious Diseases, The Ninth People's Hospital of Chongqing, Chongqing, China.
⁶ Department of Infectious Diseases, The Fifth People's Hospital of Chongqing, Chongqing, China.

^# Contributed equally.

Abstract

Background: Malnutrition, despite being a common complication, is often neglected in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). The objective of this study was to develop a simplified nutritional prognostic score to accurately predict mortality in HBV-ACLF patients.

Methods: In this multicenter retrospective study, clinical data from 530 HBV-ACLF patients were used to create a new prognostic score, which was then validated in two external cohorts (n = 229 and 248).

Results: Four independent factors were significantly associated with 28-day mortality in HBV-ACLF patients, forming a novel prognostic score (ALTA score = 0.187 × age-0.849 × lymphocyte count-2.033 × total cholesterol-0.148 × albumin-0.971). Notably, the AUROC of ALTA score for 28/90-day mortality (0.950/0.967) were significantly higher than those of three other ACLF prognostic scores (COSSH-ACLF II, 0.864/0.734; MELD, 0.525/0.488; MELD-Na, 0.546/0.517; all P < 0.001), and three known nutritional scores (CONUT, 0.739/0.861; OPNI, 0.279/0.157; NRS-2002, 0.322/0.286; all P < 0.001). The prediction error rates of ALTA score for 28-day mortality were significantly lower than COSSH-ACLF II (7.3%), MELD (14.4%), MELD-Na (12.7%), CONUT (9.0%), OPNI (30.6%), and NRS2002 (34.1%) scores. Further classifying ALTA score into two strata, the hazard ratios of mortality at 28/90 days were notably increased in the high-risk groups compared to the low-risk group (15.959 and 5.740). These results were then validated in two external cohorts.

Conclusion: ALTA, as a simplified nutritional prognostic score for HBV-ACLF, demonstrates superiority over the COSSH-ACLF II and other scores in predicting short-term mortality among HBV-ACLF patients. Therefore, it may be used to guide clinical management, particularly in primary care settings.

Keywords: acute-on-chronic liver failure; hepatitis B virus; mortality; nutrition; prognostic score.

Grants and funding

The authors declare that financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Natural Science Foundation of Chongqing (Grant No. CSTB2023NSCQ-MSX0715) and the Postgraduate Research and Innovation Projects of Chongqing Municipal Education Commission (CYS20197). Remarkable Innovation-Clinical Research Project, The Second Affiliated Hospital of Chongqing Medical University, and The First batch of key Disciplines on Public Health in Chongqing, Health Commission of Chongqing, China.