{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:01:39Z","timestamp":1753891299736,"version":"3.41.2"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"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. Med."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To develop a nomogram model based on the albumin-bilirubin (ALBI) score for predicting the 90-day prognosis of patients with acute-on-chronic liver failure (ACLF) and to evaluate its predictive efficacy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Clinical data of 290 ACLF patients at the Third People\u2019s Hospital of Nantong City, collected from December 2020 to December 2023, were analyzed. The data were divided into a training set (<jats:italic>n<\/jats:italic>\u202f=\u202f200) and a validation set (<jats:italic>n<\/jats:italic>\u202f=\u202f90), with August 2022 as the cut-off date. Patients in the training set were categorized into an improvement group (<jats:italic>n<\/jats:italic>\u202f=\u202f133) and a mortality group (<jats:italic>n<\/jats:italic>\u202f=\u202f67) based on their 90-day outcomes. The predictive power of baseline parameters was assessed using univariate and multivariate logistic regression to construct model. Model performance was assessed using receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA) and the Hosmer-Lemeshow test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Creatinine (CR) [odds ratio (OR)\u202f=\u202f1.013, 95% confidence interval (CI): 1.004\u20131.022], ALBI (OR\u202f=\u202f10.831, 95% CI: 4.009\u201333.247), Gender (OR\u202f=\u202f1.931, 95% CI: 0.973\u20133.870) and ascites (OR\u202f=\u202f3.032, 95% CI: 1.249\u20138.178) were identified as independent prognostic factors. The prognostic model formula was derived as prognostic index (PI)\u202f=\u202f\u20130.591\u202f+\u202f0.658\u202f\u00d7\u202fGender\u202f+\u202f1.109\u202f\u00d7\u202fascites\u202f+\u202f0.012\u202f\u00d7\u202fCR\u202f+\u202f2.382\u202f\u00d7\u202fALBI. The area under the curve (AUC) was 0.804 (95% CI: 0.741\u20130.866), with a specificity of 85.0% and a sensitivity of 65.7% at a cut-off of 0.425. The AUC of the validation set was 0.811 (95% CI: 0.697\u20130.926). The Hosmer-Lemeshow test indicated a good model fit with a <jats:italic>p<\/jats:italic>-value of 0.287 for the training set and 0.423 for the validation set. Calibration curves demonstrated the accuracy of the model, and DCA results suggested that the model was clinically useful when the threshold was below 0.6.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The nomogram model incorporating ALBI with CR, Gender and ascites can predict the 90-day prognosis of ACLF patients, potentially helping to optimize treatment strategies and improve patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1406275","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T07:06:38Z","timestamp":1736147198000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A nomogram model based on albumin-bilirubin score for predicting 90-day prognosis in patients with acute-on-chronic liver failure"],"prefix":"10.3389","volume":"11","author":[{"given":"Wei","family":"Ding","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiandong","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianguo","family":"Shao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhaolian","family":"Bian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong","family":"Xue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1016\/j.jhep.2023.04.021","article-title":"EASL clinical practice guidelines on acute-on-chronic liver failure","volume":"79","year":"2023","journal-title":"J Hepatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"15733","DOI":"10.1111\/liv.15733","article-title":"Mechanisms and treatment approaches for ACLF","volume":"16","author":"Piano","year":"2023","journal-title":"Liver Int"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1426","DOI":"10.1053\/j.gastro.2013.02.042","article-title":"Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis","volume":"144","author":"Moreau","year":"2013","journal-title":"Gastroenterology"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"100557","DOI":"10.1016\/j.jhepr.2022.100557","article-title":"The ALBI score: from liver function in patients with HCC to a general measure of liver function","volume":"4","author":"Toyoda","year":"2022","journal-title":"JHEP Rep"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1007\/s12072-019-09980-1","article-title":"Correction to: acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update","volume":"13","author":"Sarin","year":"2019","journal-title":"Hepatol Int"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1053\/gast.2003.50016","article-title":"Model for end-stage liver disease (MELD) and allocation of donor livers","volume":"124","author":"Wiesner","year":"2003","journal-title":"Gastroenterology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1951","DOI":"10.14309\/ajg.0000000000002748","article-title":"MELD and MELD 3.0- what it means for your practice","volume":"119","author":"Zaver","year":"2024","journal-title":"Am J Gastroenterol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1943","DOI":"10.1097\/TP.0000000000004955","article-title":"Improved waitlist outcomes in liver transplant patients with mid-MELD-Na scores listed in centers receptive to use of organs donated after circulatory death","volume":"108","author":"Miyake","year":"2024","journal-title":"Transplantation"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1032188","DOI":"10.3389\/fpubh.2022.1032188","article-title":"A nomogram for predicting lung-related diseases among construction workers in Wuhan","volume":"10","author":"Chen","year":"2022","journal-title":"Front Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"131973","DOI":"10.1016\/j.ijcard.2024.131973","article-title":"A nomogram for predicting the risk of heart failure with preserved ejection fraction","volume":"407","author":"Hua","year":"2024","journal-title":"Int J Cardiol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"107680","DOI":"10.1016\/j.jstrokecerebrovasdis.2024.107680","article-title":"Study on the correlation between serum indole-3-propionic acid levels and the progression and prognosis of acute ischemic stroke","volume":"33","author":"Li","year":"2024","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"T383","DOI":"10.1016\/j.recot.2024.03.005","article-title":"Comparative study of deep lipomas and atypical lipomatous tumours: malignancy risk factors","volume":"68","author":"Merino-Rueda","year":"2024","journal-title":"Rev Esp Cir Ortop Traumatol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1340329","DOI":"10.3389\/fendo.2024.1340329","article-title":"Development and validation of a prediction model for unexpected poor ovarian response during IVF\/ICSI","volume":"15","author":"Xu","year":"2024","journal-title":"Front Endocrinol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1334599","DOI":"10.3389\/fendo.2024.1334599","article-title":"Establishment and validation of a nomogram for subsequent first-cycle live births in patients diagnosed with recurrent implantation failure: a population-based analysis","volume":"15","author":"Zhang","year":"2024","journal-title":"Front Endocrinol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1038\/bjc.2016.212","article-title":"Prognostic nomogram and score to predict overall survival in locally advanced untreated pancreatic cancer (PROLAP)","volume":"115","author":"Vernerey","year":"2016","journal-title":"Br J Cancer"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"963559","DOI":"10.3389\/fendo.2022.963559","article-title":"A nomogram model based on clinical markers for predicting malignancy of ovarian tumors","volume":"13","author":"Gao","year":"2022","journal-title":"Front Endocrinol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"817","DOI":"10.1007\/s12072-023-10637-3","article-title":"Expert consensus on the diagnosis and treatment of end-stage liver disease complicated by infections","volume":"18","author":"Chen","year":"2024","journal-title":"Hepatol Int"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/liv.15861","article-title":"Acute and non-acute decompensation of liver cirrhosis (47\/130)","volume":"2","author":"Schulz","year":"2024","journal-title":"Liver Int"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1002\/ueg2.12538","article-title":"Acute decompensation of cirrhosis versus acute-on-chronic liver failure: what are the clinical implications?","volume":"12","author":"Xu","year":"2024","journal-title":"United European Gastroenterol J"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"126","DOI":"10.5005\/jp-journals-10071-24640","article-title":"Clinical profile, short-term prognostic accuracies of CLIF-C ACLF score and serial CLIF-C OF scores in acute-on-chronic liver failure patients: a prospective observational study","volume":"28","author":"Hareesh","year":"2024","journal-title":"Indian J Crit Care Med"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e40574","DOI":"10.7759\/cureus.40574","article-title":"Correlation of model for end stage liver disease (MELD), MELD-sodium (MELD-Na), and child-Turcotte-Pugh (CTP) score with frailty in patients with hepatitis C virus (HCV) related cirrhosis","volume":"15","author":"Panezai","year":"2023","journal-title":"Cureus"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000503921","article-title":"Child-Turcotte-Pugh score, MELD score and MELD-Na score as predictors of short-term mortality among patients with end-stage liver disease in northern India","volume":"5","author":"Acharya","year":"2020","journal-title":"Inflamm Intest Dis"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"3048","DOI":"10.21037\/apm-20-608","article-title":"The scoring systems in predicting short-term outcomes in patients with hepatitis B virus-related acute-on-chronic liver failure","volume":"9","author":"Li","year":"2020","journal-title":"Ann Palliat Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"3155","DOI":"10.2147\/RMHP.S281999","article-title":"Assessing the prediction effect of various prognosis model for 28-day mortality in acute-on-chronic liver failure patients","volume":"13","author":"Liu","year":"2020","journal-title":"Risk Manag Healthc Policy"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"29","DOI":"10.5114\/ceh.2022.114169","article-title":"Diagnostic role of simple indices in HCV-related liver cirrhosis outcomes: a prospective cross-sectional study","volume":"8","author":"Metawea","year":"2022","journal-title":"Clin Exp Hepatol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e7142","DOI":"10.1097\/MD.0000000000007142","article-title":"Albumin-bilirubin (ALBI) score at admission predicts possible outcomes in patients with acute-on-chronic liver failure","volume":"96","author":"Chen","year":"2017","journal-title":"Medicine"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1111\/1751-2980.12671","article-title":"Acute-on-chronic liver failure exists in patients with hepatitis B virus-related decompensated cirrhosis","volume":"19","author":"Wang","year":"2018","journal-title":"J Dig Dis"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"433","DOI":"10.14218\/JCTH.2022.00106","article-title":"Efficacy and economic evaluation of nonbiological artificial liver therapy in acute-on-chronic hepatitis B liver failure","volume":"11","author":"Wu","year":"2023","journal-title":"J Clin Transl Hepatol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/s12876-022-02164-6","article-title":"Models to predict the short-term survival of acute-on-chronic liver failure patients following liver transplantation","volume":"22","author":"Yang","year":"2022","journal-title":"BMC Gastroenterol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"625","DOI":"10.3748\/wjg.v16.i5.625","article-title":"Serum thymosin beta4 levels in patients with hepatitis B virus-related liver failure","volume":"16","author":"Han","year":"2010","journal-title":"World J Gastroenterol"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2200850","DOI":"10.2807\/1560-7917.ES.2023.28.1.2200850","article-title":"Molecular surveillance of multidrug-resistant gram-negative bacteria in Ukrainian patients, Germany, march to June 2022","volume":"28","author":"Schultze","year":"2023","journal-title":"Euro Surveill"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1794","DOI":"10.1159\/000494820","article-title":"Serum Procalcitonin correlates with renal function in hepatitis B virus-related acute-on-chronic liver failure","volume":"50","author":"Zheng","year":"2018","journal-title":"Cell Physiol Biochem"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1186\/s12876-020-01437-2","article-title":"A novel predictive model based on inflammatory markers to assess the prognosis of patients with HBV-related acute-on-chronic liver failure: a retrospective cohort study","volume":"20","author":"Qiang","year":"2020","journal-title":"BMC Gastroenterol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/j.cgh.2017.05.041","article-title":"New developments in Hepatorenal syndrome","volume":"16","author":"Mindikoglu","year":"2018","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1111\/tri.12008","article-title":"Model for end-stage liver disease-sodium and survival benefit in liver transplantation","volume":"26","author":"Vitale","year":"2013","journal-title":"Transpl Int"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"12548","DOI":"10.1080\/21655979.2022.2077057","article-title":"Development of a FT3-related prognostic model for patients with hepatitis B virus-related acute-on-chronic liver failure","volume":"13","author":"Zhang","year":"2022","journal-title":"Bioengineered"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"2620","DOI":"10.3390\/ijerph17082620","article-title":"Sex hormone-dependent physiology and diseases of liver","volume":"17","author":"Kur","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"925","DOI":"10.3390\/jpm12060925","article-title":"Gender and autoimmune liver diseases: relevant aspects in clinical practice","volume":"12","author":"Invernizzi","year":"2022","journal-title":"J Pers Med"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1089\/jwh.2005.14.617","article-title":"Gender-specific issues in liver and kidney failure and transplantation: a review","volume":"14","author":"Sanfey","year":"2005","journal-title":"J Women's Health"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"10654","DOI":"10.3390\/ijms231810654","article-title":"The role of sex in acute and chronic liver damage","volume":"23","author":"Sayaf","year":"2022","journal-title":"Int J Mol Sci"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"4523","DOI":"10.3390\/ijerph19084523","article-title":"Sex, gender, and alcohol use: implications for women and low-risk drinking guidelines","volume":"19","author":"Greaves","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1016\/j.jhep.2024.01.036","article-title":"Sex-determining region Y gene promotes liver fibrosis and accounts for sexual dimorphism in its pathophysiology","volume":"80","author":"Wu","year":"2024","journal-title":"J Hepatol"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1016\/j.canlet.2017.09.013","article-title":"Activation of SRY accounts for male-specific hepatocarcinogenesis: implication in gender disparity of hepatocellular carcinoma","volume":"410","author":"Liu","year":"2017","journal-title":"Cancer Lett"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1268102","DOI":"10.3389\/fmed.2023.1268102","article-title":"Prognostic assessment of liver cirrhosis and its complications: current concepts and future perspectives","volume":"10","author":"G\u00fclcicegi","year":"2023","journal-title":"Front Med"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"C129","DOI":"10.1152\/ajpcell.00101.2023","article-title":"Pathogenetic mechanisms and therapeutic approaches of acute-to-chronic liver failure","volume":"325","author":"Schierwagen","year":"2023","journal-title":"Am J Physiol Cell Physiol"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11684-016-0439-x","article-title":"Overview on acute-on-chronic liver failure","volume":"10","author":"Zhang","year":"2016","journal-title":"Front Med"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"096","DOI":"10.1055\/s-0038-1676805","article-title":"Child-Pugh classification: time to abandon?","volume":"39","author":"Kok","year":"2019","journal-title":"Semin Liver Dis"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/S0168-8278(01)00302-6","article-title":"MELD: the end of child-Pugh classification?","volume":"36","author":"Pagliaro","year":"2002","journal-title":"J Hepatol"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1016\/j.mcna.2015.12.002","article-title":"From child-Pugh to model for end-stage liver disease: deciding who needs a liver transplant","volume":"100","author":"Reddy","year":"2016","journal-title":"Med Clin North Am"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1406275\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T07:06:41Z","timestamp":1736147201000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1406275\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,6]]},"references-count":49,"alternative-id":["10.3389\/fmed.2024.1406275"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1406275","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2025,1,6]]},"article-number":"1406275"}}