{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T11:45:07Z","timestamp":1794051907579,"version":"4.8.0"},"reference-count":14,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"National Key Research and Development Programme of China","award":["2022YFC2304501, 2021YFC2301800"],"award-info":[{"award-number":["2022YFC2304501, 2021YFC2301800"]}]},{"name":"Medical Health Science and Technology Project of Zhejiang Provincial Health Commission","award":["2022RC141"],"award-info":[{"award-number":["2022RC141"]}]},{"DOI":"10.13039\/501100012226","name":"Fundamental Research Funds for the Central Universities","doi-asserted-by":"crossref","award":["226-2023-00127, 2021FZZX001-41"],"award-info":[{"award-number":["226-2023-00127, 2021FZZX001-41"]}],"id":[{"id":"10.13039\/501100012226","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Medical and Health, Science and Technology Planning Project of Zhejiang Province, China","award":["2021436801"],"award-info":[{"award-number":["2021436801"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["81870425, 81930061, 81900579, 81473641, 81271884, 81700561, 81470038, 82070650, 81660333"],"award-info":[{"award-number":["81870425, 81930061, 81900579, 81473641, 81271884, 81700561, 81470038, 82070650, 81660333"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Shanghai Hospital Development Commission","award":["SHDC2020CR1037B"],"award-info":[{"award-number":["SHDC2020CR1037B"]}]},{"DOI":"10.13039\/501100005230","name":"Chongqing Natural Science Foundation","doi-asserted-by":"crossref","award":["CSTC2019jcyj-zdxmX0004"],"award-info":[{"award-number":["CSTC2019jcyj-zdxmX0004"]}],"id":[{"id":"10.13039\/501100005230","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100007129","name":"Shandong Province Natural Science Foundation","doi-asserted-by":"crossref","award":["ZR2019PH052"],"award-info":[{"award-number":["ZR2019PH052"]}],"id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["egastro"],"accepted":{"date-parts":[[2024,7,25]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The model for end-stage liver disease (MELD) score is widely used for the prognostication in end-stage liver disease but has limited performance in acute-on-chronic liver failure (ACLF). In this study, we identified additional predictive parameters and reformed the MELD score to predict ACLF more accurately.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A meta-analysis was performed on relevant studies to identify the predictive factors of 28-day\/90-day outcomes of ACLF, which were validated in two large prospective cohorts. A prognostic score was developed by incorporating predictive parameters into the MELD score. The model was evaluated with a focus on discrimination and calibration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The meta-analysis incorporated 32 cohort studies with a total of 13\u2009939 patients, of which 13 risk factors were identified, and 3 risk factors (age, neutrophil count and hepatic encephalopathy (HE) grade) besides MELD score were validated in 751 patients with ACLF derived from two prospective cohorts. A new model (Chinese Acute-on-Chronic Liver Failure Consortium (CATCH-LIFE)-MELD score) was developed as follows: 0.028\u00d7age+0.3\u00d7HE grade+0.039\u00d7neutrophil count+0.079\u00d7MELD score. CATCH-LIFE-MELD score achieved a concordance index of 0.791\/0.788 for 28-day\/90-day outcomes, which is superior to other traditional scores. Other discrimination indices, including net reclassification improvement, integrated discrimination improvement and probability density function, and calibration including Nagelkerke\u2019s R<jats:sup>2<\/jats:sup> and Brier scores confirmed its superiority. Moreover, the accuracy of CATCH-LIFE-MELD score remained stable. It was highest in patients with or without hepatitis B virus infection, cirrhosis, liver failure or under the Chinese Group on the Study of Severe Hepatitis B (COSSH) criteria or European Association for the Study of the Liver (EASL) criteria. All results were substantiated by an evaluation using an external cohort.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>CATCH-LIFE-MELD score, a modified MELD score exhibited improved accuracy in predicting the short-term prognosis of ACLF than other traditional scores.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/egastro-2024-100101","type":"journal-article","created":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T10:45:32Z","timestamp":1727779532000},"page":"e100101","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failure"],"prefix":"10.1136","volume":"2","clinical-trial-number":[{"clinical-trial-number":"nct02457637","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03641872","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Xia","family":"Yu","sequence":"first","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruoqi","family":"Zhou","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenting","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaobo","family":"Wang","sequence":"additional","affiliation":[{"name":"Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinjun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beiling","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinxin","family":"Liu","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongji","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanhang","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Hepatology, The First Hospital of Jilin University, Changchun, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiping","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Liu","sequence":"additional","affiliation":[{"name":"Tianjin Institute of Hepatology, Nankai University Second People's Hospital, Tianjin, China"},{"name":"Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaobo","family":"Lu","sequence":"additional","affiliation":[{"name":"Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 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China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Southwest Hospital, Third Military Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixin","family":"Hou","sequence":"additional","affiliation":[{"name":"Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shue","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and 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China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuhua","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sen","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer, Taihe Hospital, Hubei University of Medicine, Shiyan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Hepatology, The First Hospital of Jilin University, Changchun, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinming","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Hepatology, The First Hospital of Jilin University, Changchun, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liujuan","family":"Ji","sequence":"additional","affiliation":[{"name":"Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Mei","sequence":"additional","affiliation":[{"name":"Department of Liver Intensive Care Unit, Shanghai Public Health Clinical Centre, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Hepatology, The Second Hospital of Shandong University, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongjiong","family":"Zheng","sequence":"additional","affiliation":[{"name":"Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyi","family":"Zhou","sequence":"additional","affiliation":[{"name":"Infectious Disease Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qun","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Liver Diseases, Ningbo Medical Center Lihuili Hospital, Affiliated Lihuili Hospital of Ningbo University, Ningbo, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hai","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jifang","family":"Sheng","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Shi","sequence":"additional","affiliation":[{"name":"State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,10,1]]},"reference":[{"key":"2025081719100760000_2.3.e100101.1","doi-asserted-by":"crossref","unstructured":"Piano S , Mahmud N , Caraceni P , et al . Mechanisms and treatment approaches for ACLF. Liver Int 2023. doi:10.1111\/liv.15733","DOI":"10.1111\/liv.15733"},{"key":"2025081719100760000_2.3.e100101.2","article-title":"Transplantation for EASL-CLIF and APASL acute-on-chronic liver failure (ACLF) patients: the TEA cohort to evaluate long-term post-transplant outcomes","volume":"49","author":"Xia","year":"2022","journal-title":"E Clin Med"},{"key":"2025081719100760000_2.3.e100101.3","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1016\/j.jhep.2021.06.017","article-title":"\u201cEquity\u201d and \u201cJustice\u201d for patients with acute-on chronic liver failure: a call to action","volume":"75","author":"Jalan","year":"2021","journal-title":"J Hepatol"},{"key":"2025081719100760000_2.3.e100101.4","doi-asserted-by":"publisher","DOI":"10.1053\/he.2000.5852"},{"key":"2025081719100760000_2.3.e100101.5","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2006.02.010"},{"key":"2025081719100760000_2.3.e100101.6","first-page":"838","article-title":"Clinical prediction models for hepatitis b virus-related acute-on-chronic liver failure: a technical report","volume":"9","author":"Yu","year":"2021","journal-title":"J Clin Transl Hepatol"},{"key":"2025081719100760000_2.3.e100101.7","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1111\/hepr.12362","article-title":"A novel integrated model for end-stage liver disease model predicts short-term prognosis of hepatitis B virus-related acute-on-chronic liver failure patients","volume":"45","author":"Yan","year":"2015","journal-title":"Hepatol Res"},{"key":"2025081719100760000_2.3.e100101.8","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1093\/aje\/kwy083","article-title":"Acute-on-chronic liver failure in china: rationale for developing a patient registry and baseline characteristics","volume":"187","author":"Gu","year":"2018","journal-title":"Am J Epidemiol"},{"key":"2025081719100760000_2.3.e100101.9","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-037793","article-title":"Cohort profile: a multicentre prospective validation cohort of the Chinese acute-on-chronic liver failure (CATCH-LIFE) study","volume":"11","author":"Qiao","year":"2021","journal-title":"BMJ Open"},{"key":"2025081719100760000_2.3.e100101.10","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1097\/TP.0000000000004767","article-title":"Living donor liver transplantation for adults with high model for end-stage liver disease score: the US experience","volume":"108","author":"Rosenthal","year":"2024","journal-title":"Transplantation"},{"key":"2025081719100760000_2.3.e100101.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.06.012"},{"key":"2025081719100760000_2.3.e100101.12","doi-asserted-by":"crossref","first-page":"620365","DOI":"10.3389\/fimmu.2021.620365","article-title":"Circulating neutrophil dysfunction in hbv-related acute-on-chronic liver failure","volume":"12","author":"Wu","year":"2021","journal-title":"Front Immunol"},{"key":"2025081719100760000_2.3.e100101.13","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1111\/apt.15932","article-title":"Leucocyte ratios are biomarkers of mortality in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure","volume":"52","author":"Bernsmeier","year":"2020","journal-title":"Aliment Pharmacol Ther"},{"key":"2025081719100760000_2.3.e100101.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2016.09.157"}],"container-title":["eGastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/egastro-2024-100101","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T02:13:05Z","timestamp":1755483185000},"score":1,"resource":{"primary":{"URL":"http:\/\/egastroenterology.bmj.com\/lookup\/doi\/10.1136\/egastro-2024-100101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10]]},"references-count":14,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2024,10,1]]},"published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1136\/egastro-2024-100101"],"URL":"https:\/\/doi.org\/10.1136\/egastro-2024-100101","relation":{},"ISSN":["2766-0125","2976-7296"],"issn-type":[{"value":"2766-0125","type":"print"},{"value":"2976-7296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10]]}}}