{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T16:03:29Z","timestamp":1785168209253,"version":"3.55.0"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T00:00:00Z","timestamp":1594252800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T00:00:00Z","timestamp":1594252800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n            <jats:title>Background and Aims<\/jats:title>\n            <jats:p>The prognosis in severe acute flares of chronic hepatitis B (AFOCHB) is often unclear. The current study aimed to establish the predictive value using the Model for End\u2010Stage Liver Disease (MELD) score for short\u2010term mortality for severe AFOCHB.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Approach and Results<\/jats:title>\n            <jats:p>Patients with severe AFOCHB with bilirubin &gt; 50 \u00b5mol\/L, alanine aminotransferase &gt; 10\u00d7 upper limit of normal, and international normalized ratio &gt; 1.5 were included. All patients were commenced on entecavir and\/or tenofovir. Laboratory results and MELD scores were pooled to calculate mortality at four time points (days 7, 14, 21, and 28). A total of 240 patients were included. Median hepatitis B virus DNA was 7.77 log IU\/mL (range, 4.11\u201010.06), and 49 (20.4%) were hepatitis B e antigen\u2013positive. The 7, 14, 21, and 28\u2010day survival was 96.7%, 88.5%, 79.5%, and 72.8%, respectively. Using pooled results derived from 4,201 blood samples, the area under the receiver operating curve for the MELD score to predict day 7, 14, 21, and 28 mortality was 0.909, 0.892, 0.883, and 0.871, respectively. For MELD \u2264 28, mortality at day 28 was low (&lt;25%) compared with &gt; 50% mortality for MELD \u2265 32. For MELD = 28\u201032, higher day\u201028 mortality was observed for four criteria: age \u226552 years, alanine aminotransferase &gt; 217 U\/L, platelets &lt; 127, and abnormal baseline imaging (all <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001). In this MELD bracket, the 28\u2010day mortality was 0%, 12.1%, 23.8%, 59.4%, and 78.8% for the presence of zero, one, two, three, and four criteria, respectively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>MELD score at any time points can accurately predict the short\u2010term mortality. Patients with MELD \u2265 28 should be worked up for liver transplantation, and those with MELD = 28\u201032 with three to four at\u2010risk criteria, or MELD \u2265 32 should be listed.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1002\/hep.31086","type":"journal-article","created":{"date-parts":[[2019,12,24]],"date-time":"2019-12-24T01:11:06Z","timestamp":1577149866000},"page":"818-828","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":11,"title":["Model for End\u2010Stage Liver Disease With Additional Criteria to Predict Short\u2010Term Mortality in Severe Flares of Chronic Hepatitis B"],"prefix":"10.1097","volume":"72","author":[{"given":"James","family":"Fung","sequence":"first","affiliation":[{"name":"Department of Medicine,The University of Hong Kong,Hong Kong SAR,China"},{"name":"The Liver Transplant Center,Queen Mary Hospital,Hong Kong SAR,China"},{"name":"State Key Laboratory of Liver Research,The University of Hong Kong,Hong Kong SAR,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2266-3935","authenticated-orcid":false,"given":"Lung\u2010Yi","family":"Mak","sequence":"additional","affiliation":[{"name":"Department of Medicine,The University of Hong Kong,Hong Kong SAR,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert Chi\u2010Yan","family":"Chan","sequence":"additional","affiliation":[{"name":"The Liver Transplant Center,Queen Mary Hospital,Hong Kong SAR,China"},{"name":"State Key Laboratory of Liver Research,The University of Hong Kong,Hong Kong SAR,China"},{"name":"Department of Surgery,The University of Hong Kong,Hong Kong SAR,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth Siu\u2010Ho","family":"Chok","sequence":"additional","affiliation":[{"name":"The Liver Transplant Center,Queen Mary Hospital,Hong Kong SAR,China"},{"name":"State Key Laboratory of Liver Research,The University of Hong Kong,Hong Kong SAR,China"},{"name":"Department of Surgery,The University of Hong Kong,Hong Kong SAR,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiffany Cho\u2010Lam","family":"Wong","sequence":"additional","affiliation":[{"name":"The Liver Transplant Center,Queen Mary Hospital,Hong Kong SAR,China"},{"name":"Department of Surgery,The University of Hong Kong,Hong Kong SAR,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tan\u2010To","family":"Cheung","sequence":"additional","affiliation":[{"name":"The Liver Transplant Center,Queen Mary Hospital,Hong Kong SAR,China"},{"name":"State Key Laboratory of Liver Research,The University of Hong Kong,Hong Kong SAR,China"},{"name":"Department of Surgery,The University of Hong Kong,Hong Kong SAR,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wing\u2010Chiu","family":"Dai","sequence":"additional","affiliation":[{"name":"The Liver Transplant Center,Queen Mary Hospital,Hong Kong SAR,China"},{"name":"Department of Surgery,The University of Hong Kong,Hong Kong SAR,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sui\u2010Ling","family":"Sin","sequence":"additional","affiliation":[{"name":"The Liver Transplant Center,Queen Mary Hospital,Hong Kong SAR,China"},{"name":"Department of Surgery,The University of Hong Kong,Hong Kong SAR,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wong\u2010Hoi","family":"She","sequence":"additional","affiliation":[{"name":"The Liver Transplant Center,Queen Mary Hospital,Hong Kong SAR,China"},{"name":"Department of Surgery,The University of Hong Kong,Hong Kong SAR,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ka\u2010Wing","family":"Ma","sequence":"additional","affiliation":[{"name":"The Liver Transplant Center,Queen Mary Hospital,Hong Kong SAR,China"},{"name":"Department of Surgery,The University of Hong Kong,Hong Kong SAR,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9012-313X","authenticated-orcid":false,"given":"Wai\u2010Kay","family":"Seto","sequence":"additional","affiliation":[{"name":"Department of Medicine,The University of Hong Kong,Hong Kong SAR,China"},{"name":"State Key Laboratory of Liver Research,The University of Hong Kong,Hong Kong SAR,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching\u2010Lung","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Medicine,The University of Hong Kong,Hong Kong SAR,China"},{"name":"State Key Laboratory of Liver Research,The University of Hong Kong,Hong Kong SAR,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung\u2010Mau","family":"Lo","sequence":"additional","affiliation":[{"name":"The Liver Transplant Center,Queen Mary Hospital,Hong Kong SAR,China"},{"name":"State Key Laboratory of Liver Research,The University of Hong 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