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The aims of the present study were to investigate the subgroups of patients with HBV-ACLF who may benefit from ALSS therapy, and the relevant patient-specific factors. 489 ALSS-treated HBV-ACLF patients were enrolled, and served as derivation and validation cohorts for classification and regression tree (CART) analysis. CART analysis identified three factors prognostic of survival: hepatic encephalopathy (HE), prothrombin time (PT), and total bilirubin (TBil) level; and two distinct risk groups: low (28-day mortality 10.2\u201339.5%) and high risk (63.8\u201391.1%). The CART model showed that patients lacking HE and with a PT\u2009\u2264\u200927.8\u2009s and a TBil level \u2264455\u2009\u03bcmol\/L experienced less 28-day mortality after ALSS therapy. For HBV-ACLF patients with HE and a PT\u2009&gt;\u200927.8\u2009s, mortality remained high after such therapy. Patients lacking HE with a PT\u2009\u2264\u200927.8\u2009s and TBil level\u2009\u2264\u2009455\u2009\u03bcmol\/L may benefit markedly from ALSS therapy. For HBV-ACLF patients at high risk, unnecessary ALSS therapy should be avoided. The CART model is a novel user-friendly tool for screening HBV-ACLF patient eligibility for ALSS therapy, and will aid clinicians via ACLF risk stratification and therapeutic guidance.<\/jats:p>","DOI":"10.1038\/s41598-019-53029-0","type":"journal-article","created":{"date-parts":[[2019,11,11]],"date-time":"2019-11-11T11:03:16Z","timestamp":1573470196000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Artificial liver support system therapy in acute-on-chronic hepatitis B liver failure: Classification and regression tree analysis"],"prefix":"10.1038","volume":"9","author":[{"given":"Kaizhou","family":"Huang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feiyang","family":"Ji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhongyang","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daxian","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaowei","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hainv","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoxi","family":"Ouyang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lanlan","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Menghao","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danhua","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lanjuan","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,11,11]]},"reference":[{"key":"53029_CR1","doi-asserted-by":"publisher","first-page":"1561","DOI":"10.1136\/gut.2009.189639","volume":"59","author":"A Katoonizadeh","year":"2010","unstructured":"Katoonizadeh, A. et al. 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