{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T06:01:57Z","timestamp":1785132117734,"version":"3.55.0"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"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 &amp;amp; aims<\/jats:title>\n                    <jats:p>Patients who do not meet the criteria for Acute-on-Chronic Liver Failure (ACLF) at admission still face a high risk of disease progression and mortality. This study aimed to develop and validate a machine learning-derived clinical tool for the early identification of HBV-pre-ACLF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed 1,682 patients experiencing acute deterioration of HBV-related chronic liver disease but without ACLF. By random forest and SHAP analysis, we identified key predictors of ACLF onset within a 7-day window. We then validated the diagnostic thresholds in a test cohort of 260 patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Total bilirubin (TBIL) and INR were identified as the most critical predictors of ACLF progression. We established optimal diagnostic thresholds at TBIL \u2265131.5 \u03bcmol\/L and INR \u22651.35. Two sequential criteria were developed: pre-ACLF-O (meeting either threshold) for highly sensitive screening, and pre-ACLF-A (meeting both thresholds) for risk confirmation. In the derivation cohort, pre-ACLF-O achieved 98.3% sensitivity, while pre-ACLF-A predicted a 33.09% positive predictive value. These results were successfully validated in the test cohort, where pre-ACLF-O maintained 100% sensitivity and pre-ACLF-A demonstrated a 37.04% positive predictive value.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This dual-indicator tool easily and effectively identifies HBV-pre-ACLF. Using these criteria sequentially provides a practical strategy for early risk stratification, allowing clinicians to initiate timely interventions for high-risk patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1865757","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:41:33Z","timestamp":1785130893000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a machine learning-derived dual-indicator tool for identification of hepatitis B virus-related pre-acute-on-chronic liver failure"],"prefix":"10.3389","volume":"16","author":[{"given":"Tianyi","family":"Zhang","sequence":"first","affiliation":[{"name":"Chinese PLA General Hospital","place":["Beijing, China"]},{"name":"Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaoli","family":"You","sequence":"additional","affiliation":[{"name":"Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinjin","family":"Luo","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, The First Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Ling","sequence":"additional","affiliation":[{"name":"Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sa","family":"Lv","sequence":"additional","affiliation":[{"name":"Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiwen","family":"Xu","sequence":"additional","affiliation":[{"name":"Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaojie","family":"Xin","sequence":"additional","affiliation":[{"name":"Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohe","family":"Xiao","sequence":"additional","affiliation":[{"name":"Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Li","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, The First Affiliated Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing","family":"Zhu","sequence":"additional","affiliation":[{"name":"Senior Department of Hepatology, Fifth Medical Center of Chinese PLA General Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1136\/gutjnl-2014-308874","article-title":"Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites","volume":"64","author":"Angeli","year":"2015","journal-title":"Gut"},{"key":"B2","doi-asserted-by":"publisher","first-page":"764","DOI":"10.1136\/gutjnl-2019-319720","article-title":"Recent advances in alcohol-related liver disease (ALD): summary of a Gut round table meeting","volume":"69","author":"Avila","year":"2020","journal-title":"Gut"},{"key":"B3","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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