{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T17:28:19Z","timestamp":1792258099461,"version":"4.4.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2019,2,17]],"date-time":"2019-02-17T00:00:00Z","timestamp":1550361600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2019,2,17]],"date-time":"2019-02-17T00:00:00Z","timestamp":1550361600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>Acute liver failure (ALF) caused by hepatitis A is a rare but fatal disease. Here, we developed a model to predict outcome in patients with ALF caused by hepatitis A. The derivation set consisted of 294 patients diagnosed with hepatitis A\u2013related ALF (ALFA) from Korea, and a validation set of 56 patients from Japan, India, and United Kingdom. Using a multivariate proportional hazard model, a risk\u2010prediction model (ALFA score) consisting of age, international normalized ratio, bilirubin, ammonia, creatinine, and hemoglobin levels acquired on the day of ALF diagnosis was developed. The ALFA score showed the highest discrimination in the prediction of liver transplant or death at 1 month (c\u2010statistic, 0.87; 95% confidence interval [CI], 0.84\u20100.92) versus King\u2019s College criteria (KCC; c\u2010statistic, 0.56; 95% CI, 0.53\u20100.59), U.S. Acute Liver Failure Study Group index specific for hepatitis A virus (HAV\u2010ALFSG; c\u2010statistic, 0.70; 95% CI, 0.65\u20100.76), the new ALFSG index (c\u2010statistic, 0.79; 95% CI, 0.74\u20100.84), Model for End\u2010Stage Liver Disease (MELD; c\u2010statistic, 0.79; 95% CI, 0.74\u20100.84), and MELD including sodium (MELD\u2010Na; c\u2010statistic, 0.78; 95% CI, 0.73\u20100.84) in the derivation set (all<jats:italic toggle=\"yes\">P<\/jats:italic>&lt; 0.01). In the validation set, the performance of the ALFA score (c\u2010statistic, 0.84; 95% CI, 0.74\u20100.94) was significantly better than that of KCC (c\u2010statistic, 0.65; 95% CI, 0.52\u20100.79), MELD (c\u2010statistic, 0.74; 95% CI, 0.61\u20100.87), and MELD\u2010Na (c\u2010statistic, 0.72; 95% CI, 0.58\u20100.85) (all<jats:italic toggle=\"yes\">P<\/jats:italic>&lt; 0.05), and better, but not statistically significant, than that of the HAV\u2010ALFSG (c\u2010statistic, 0.76; 95% CI, 0.61\u20100.90;<jats:italic toggle=\"yes\">P<\/jats:italic>= 0.28) and new ALFSG indices (c\u2010statistic, 0.79; 95% CI, 0.65\u20100.93;<jats:italic toggle=\"yes\">P<\/jats:italic>= 0.41). The model was well\u2010calibrated in both sets.<jats:italic toggle=\"yes\">Conclusion:<\/jats:italic>Our disease\u2010specific score provides refined prediction of outcome in patients with ALF caused by hepatitis A.<\/jats:p>","DOI":"10.1002\/hep.30262","type":"journal-article","created":{"date-parts":[[2018,9,8]],"date-time":"2018-09-08T11:57:02Z","timestamp":1536407822000},"page":"621-629","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":32,"title":["A Model to Predict 1\u2010Month Risk of Transplant or Death in Hepatitis A\u2013Related Acute Liver Failure"],"prefix":"10.1097","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9660-6303","authenticated-orcid":false,"given":"Jin Dong","family":"Kim","sequence":"first","affiliation":[{"name":"Catholic University Liver Research Center & WHO Collaborating Center of Viral Hepatitis,Catholic University of Korea College of Medicine,Seoul,Korea"},{"name":"Department of Internal Medicine,Cheju Halla General Hospital,Jeju,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2677-3189","authenticated-orcid":false,"given":"Eun Ju","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Liver Research Institute,Seoul National University College of Medicine,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Choonghyun","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine,Seoul National University College of Medicine,Seoul,Korea"},{"name":"Department of Biomedical Science,Seoul National University Graduate School,Seoul,Korea"},{"name":"Cancer Research Institute, Seoul National University,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue K.","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine,Seoul National University College of Medicine,Seoul,Korea"},{"name":"Department of Biomedical Science,Seoul National University Graduate School,Seoul,Korea"},{"name":"Cancer Research Institute, Seoul National University,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong Young","family":"Choi","sequence":"additional","affiliation":[{"name":"Catholic University Liver Research Center & WHO Collaborating Center of Viral Hepatitis,Catholic University of Korea College of Medicine,Seoul,Korea"},{"name":"Department of Internal Medicine,Catholic University of Korea College of Medicine,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Chu","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Asan Medical Center,University of Ulsan College of Medicine,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8327-3439","authenticated-orcid":false,"given":"Do Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Yonsei University College of Medicine,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moon Seok","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Samsung Medical Center,Sungkyunkwan University School of Medicine,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hee Jung","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Surgery,Ajou University School of Medicine,Suwon,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In Hee","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Research Institute of Clinical Medicine, Chonbuk National University Medical School and Hospital,Jeonju,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong Eun","family":"Yeon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Korea University College of Medicine,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeon Seok","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Korea University College of Medicine,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1914-5141","authenticated-orcid":false,"given":"Won Young","family":"Tak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Kyungpook National University School of Medicine,Daegu,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moon Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Yonsei University Wonju College of Medicine,Wonju,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heon Ju","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Yeungnam University College of Medicine,Daegu,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun Soo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Gachon University School of Medicine,Incheon,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2875-6139","authenticated-orcid":false,"given":"Dae Won","family":"Jun","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Hanyang University College of Medicine,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joo Hyun","family":"Sohn","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Hanyang University College of Medicine,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"So Young","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Konkuk University School of Medicine,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Hoon","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Hallym Univesity College of Medicine,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong","family":"Heo","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Pusan National University School of Medicine,Busan,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sook\u2010Hyang","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine,Seoul National University Bundang Hospital,Seongnam,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0315-2080","authenticated-orcid":false,"given":"Jeong\u2010Hoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Liver Research Institute,Seoul National University College of Medicine,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuaki","family":"Nakayama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Saitama Medical University,Moroyama,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Mochida","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology,Saitama Medical University,Moroyama,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akio","family":"Ido","sequence":"additional","affiliation":[{"name":"Department of Digestive and Life\u2010Style Related Disease,Health Research Course, Human and Environmental Sciences, Kagoshima University Graduate School of Medical and Dental Sciences,Kagoshima,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirohito","family":"Tsubouchi","sequence":"additional","affiliation":[{"name":"Kagoshima City Hospital,Kagoshima,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazime","family":"Takikawa","sequence":"additional","affiliation":[{"name":"Department of Medicine,Teikyo University School of Medicine,Tokyo,Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Shalimar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology,All India Institute of Medical Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subrat Kumar","family":"Acharya","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology,All India Institute of Medical Sciences,New Delhi,India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Bernal","sequence":"additional","affiliation":[{"name":"Institute of Liver Studies,King\u2019s College Hospital,London,United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"O\u2019Grady","sequence":"additional","affiliation":[{"name":"Institute of Liver Studies,King\u2019s College Hospital,London,United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoon Jun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Liver Research Institute,Seoul National University College of Medicine,Seoul,Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,2,17]]},"reference":[{"key":"hep30262-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1001\/jama.294.2.194","article-title":"Incidence of 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A single centre experience of 3300 patients","volume":"59","year":"2013","journal-title":"J Hepatol"},{"key":"hep30262-bib-0017-20241017","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1002\/hep.25551","article-title":"Introduction to the revised American Association for the Study of Liver Diseases Position Paper on acute liver failure 2011","volume":"55","year":"2012","journal-title":"Hepatology"},{"key":"hep30262-bib-0018-20241017","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/0016-5085(89)90081-4","article-title":"Early indicators of prognosis in fulminant hepatic failure","volume":"97","year":"1989","journal-title":"Gastroenterology"},{"key":"hep30262-bib-0019-20241017","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1002\/hep.21439","article-title":"Fulminant hepatitis A virus infection in the United States: incidence, prognosis, and outcomes","volume":"44","year":"2006","journal-title":"Hepatology"},{"issue":"\u2010","key":"hep30262-bib-0020-20241017","first-page":"1199","article-title":"Development of a model to predict transplant\u2010free survival of patients with acute liver failure","volume":"14","year":"2016","journal-title":"Clin Gastroenterol Hepatol"},{"key":"hep30262-bib-0022-20241017","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1002\/sim.4067","article-title":"Multiple imputation using chained equations: Issues and guidance for practice","volume":"30","year":"2011","journal-title":"Stat Med"},{"key":"hep30262-bib-0023-20241017","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/S0168-8278(97)80010-4","article-title":"Early indicators of prognosis in fulmitant hepatic failure: an assessment of the King\u2019s criteria","volume":"26","year":"1997","journal-title":"J Hepatology"},{"key":"hep30262-bib-0024-20241017","doi-asserted-by":"crossref","first-page":"2097","DOI":"10.1016\/j.transproceed.2006.06.004","article-title":"MELD score as a prognostic model for listing acute liver failure patients for liver transplantation","volume":"38","year":"2006","journal-title":"Transplant Proc"},{"key":"hep30262-bib-0025-20241017","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1002\/lt.21104","article-title":"MELD is superior to King\u2019s college and Clichy's criteria to assess prognosis in fulminant hepatic failure","volume":"13","year":"2007","journal-title":"Liver Transpl"},{"key":"hep30262-bib-0026-20241017","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.jclinepi.2004.06.017","article-title":"Substantial effective sample sizes were required for external validation studies of predictive logistic regression models","volume":"58","year":"2005","journal-title":"J Clin Epidemiol"},{"key":"hep30262-bib-0027-20241017","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1002\/hep.20703","article-title":"American Association for the Study of Liver D. 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