{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T01:00:39Z","timestamp":1770685239550,"version":"3.49.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prognostic assessment in acute-on-chronic liver failure (ACLF), particularly in HBV-endemic regions, remains challenging due to the limited accuracy of conventional models. We aimed to develop and validate a novel, machine learning-based model incorporating liver reserve function to improve individualized prediction of short-term outcomes in HBV-ACLF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Baseline demographics, clinical features, laboratory findings, and 90-day follow-up data were retrospectively collected from 496 patients (training\/internal subgroups) and 52 patients (external validation) with HBV-ACLF. Twelve machine learning algorithms were systematically evaluated for prognostic performance. The optimal model was established using the LASSO-RF approach, with key variables identified by SHAP values. Model accuracy was assessed by ROC analysis and compared with MELD and CTP scores. An interactive web calculator (\n                      <jats:ext-link>https:\/\/syx123.shinyapps.io\/deploy_shiny\/<\/jats:ext-link>\n                      ) was developed to facilitate clinical use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We initially screened 23 potential clinical risk factors for predicting ACLF prognosis. Subsequently, using the LASSO-RF model, 15 key variables were selected for model construction. The final LASSO-RF model achieved an AUC of 0.99 in the training cohort and 0.98 in the validation cohort for predicting 90-day mortality, outperforming conventional scoring systems such as MELD and CTP. To facilitate clinical application, an online tool (\n                      <jats:ext-link>https:\/\/syx123.shinyapps.io\/deploy_shiny\/<\/jats:ext-link>\n                      ) was developed to provide real-time risk scores and 90-day mortality predictions for individual patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Liver reserve function indicators, particularly EHBF and ICG-R15, play a pivotal role in prognosticating HBV-ACLF outcomes. The developed model and its accompanying online tool enable accurate risk stratification and have the potential to guide timely and individualized clinical management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1759738","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T07:29:07Z","timestamp":1770622147000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a prognostic model for acute-on-chronic liver failure"],"prefix":"10.3389","volume":"16","author":[{"given":"Xia","family":"Zhu","sequence":"first","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]},{"name":"Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming","family":"Wang","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]},{"name":"Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanji","family":"Ma","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]},{"name":"Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Libo","family":"Yan","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]},{"name":"Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianhao","family":"Li","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]},{"name":"Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Guizhou Provincial People\u2019s Hospital","place":["Guizhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Guizhou Provincial People\u2019s Hospital","place":["Guizhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Tang","sequence":"additional","affiliation":[{"name":"Center of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]},{"name":"Laboratory of Infectious and Liver Diseases, Institute of Infectious Diseases, West China Hospital of Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"225","DOI":"10.14309\/ajg.0000000000001595","article-title":"Acute-on-chronic liver failure clinical guidelines","volume":"117","author":"Bajaj","year":"2022","journal-title":"Am. 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