{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T12:03:34Z","timestamp":1784289814355,"version":"3.55.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"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>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute-on-chronic liver failure patients have high short-term mortality rates, and HBV infection is the most common cause. Current prognostic models for HBV-ACLF patients have limitations. Thus, the development of an ideal model remains an important unsolved problem.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To develop a new model and validate its prognostic predictive capacity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Among 5854 liver failure patients admitted to the Second Affiliated Hospital of Chongqing Medical University from 2008 to 2023, 1170 HBV-ACLF cases were finally enrolled, which were randomly divided into a development cohort (\n                      <jats:italic>n<\/jats:italic>\n                      = 822) or validation cohort (\n                      <jats:italic>n<\/jats:italic>\n                      = 348). First, we obtained important predictive factors about 28-day and 90-day mortality using cox regression analysis and developed new prognostic scores. Second, the new scores were compared with current models through ROC curves, calibration curves and DCA curves. Third, using survival analysis, the new scores were risk-stratified according to optimal cut-off values.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The AHF-MELD and AHN-MELD scores\u2019 predictive capacity were stronger than MELD, MELD-sodium, CLIF-C OF and AARC scores and comparable to CLIF-C ACLF, COSSH ACLF and COSSH ACLF II scores. There was no significant difference between the observed and the predicted 28-day and 90-day mortality probabilities of new scores. The AHF-MELD and AHN-MELD scores have positive net benefits over a wide range of threshold probabilities and outperform conventional scores. The 28-day and 90-day survival rates were significantly lower in high-risk groups than in low-risk groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The AHF-MELD and AHN-MELD scores may serve as potential predictive tools for the short-term prognosis of HBV-ACLF patients. Our study may provide useful information for clinicians managing these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1837035","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:10:14Z","timestamp":1784286614000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and validation of a novel prognostic score for HBV-related acute-on-chronic liver failure"],"prefix":"10.3389","volume":"13","author":[{"given":"Qian","family":"Song","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanfei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhechuan","family":"Mei","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]},{"name":"Chongqing Municipal Health Commission Key Laboratory of Precision Diagnosis and Treatment of Liver Cirrhosis and Complications, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shengtao","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"B1","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":"B2","doi-asserted-by":"publisher","first-page":"2137","DOI":"10.1056\/NEJMra1914900","article-title":"Acute-on-chronic liver failure.","volume":"382","author":"Arroyo","year":"2020","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1007\/s12072-019-09946-3","article-title":"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":"B4","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 J Gastroenterol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1146\/annurev-med-051322-122539","article-title":"MELD 3.0 in advanced chronic liver disease.","volume":"75","author":"Mazumder","year":"2024","journal-title":"Annu Rev Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1007\/s12072-017-9816-z","article-title":"Liver failure determines the outcome in patients of acute-on-chronic liver failure (ACLF): comparison of APASL ACLF research consortium (AARC) and CLIF-SOFA models.","volume":"11","author":"Choudhury","year":"2017","journal-title":"Hepatol Int"},{"key":"B7","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1136\/gutjnl-2016-312670","article-title":"Acute-on-chronic liver failure: an update.","volume":"66","author":"Hernaez","year":"2017","journal-title":"Gut"},{"key":"B8","doi-asserted-by":"publisher","first-page":"670","DOI":"10.3350\/cmh.2022.0103","article-title":"Acute-on-chronic liver failure: terminology, mechanisms and management.","volume":"29","author":"Br","year":"2023","journal-title":"Clin Mol Hepatol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.1016\/j.jhep.2021.05.026","article-title":"Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure.","volume":"75","author":"Li","year":"2021","journal-title":"J Hepatol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1016\/j.jhep.2014.06.012","article-title":"Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure.","volume":"61","author":"Jalan","year":"2014","journal-title":"J Hepatol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2367","DOI":"10.1002\/hep.29773","article-title":"NACSELD acute-on-chronic liver failure (NACSELD-ACLF) score predicts 30-day survival in hospitalized patients with cirrhosis.","volume":"67","author":"O\u2019Leary","year":"2018","journal-title":"Hepatology"},{"key":"B12","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1016\/j.cgh.2022.03.016","article-title":"Predicting the onset of hepatitis B virus-related acute-on-chronic liver failure.","volume":"21","author":"Luo","year":"2023","journal-title":"Clin Gastroenterol Hepatol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1007\/s12072-021-10268-6","article-title":"Establishment and validation of a prognostic model for hepatitis B virus-related acute-on-chronic liver failure patients with bacterial infection.","volume":"16","author":"Zhang","year":"2022","journal-title":"Hepatol Int"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2181","DOI":"10.1136\/gutjnl-2017-314641","article-title":"Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure.","volume":"67","author":"Wu","year":"2018","journal-title":"Gut"},{"key":"B15","doi-asserted-by":"publisher","first-page":"103365","DOI":"10.1016\/j.eclinm.2025.103365","article-title":"Development and validation of a novel prognostic model to predict 1-year post-transplant mortality for acute-on-chronic hepatitis B liver failure: a nationwide, multicentre, cohort study.","volume":"86","author":"Zhuang","year":"2025","journal-title":"EClinicalMedicine."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e28183","DOI":"10.1002\/jmv.28183","article-title":"Serum ferritin diagnosis and prediction of hepatitis B virus-related acute-on-chronic liver failure.","volume":"95","author":"Luo","year":"2023","journal-title":"J Med Virol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"411","DOI":"10.1038\/s41575-025-01159-4","article-title":"Acute-on-chronic liver failure: pathophysiological mechanisms and clinical management.","volume":"23","author":"Sarin","year":"2026","journal-title":"Nat Rev Gastroenterol Hepatol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1053\/he.2000.5852","article-title":"A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts.","volume":"31","author":"Malinchoc","year":"2000","journal-title":"Hepatology"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e0354","DOI":"10.1097\/HC9.0000000000000354","article-title":"The clinical courses of HBV-related acute-on-chronic liver failure and a multi-state model to predict disease evolution.","volume":"8","author":"Yu","year":"2024","journal-title":"Hepatol Commun"},{"key":"B20","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1097\/HEP.0000000000000352","article-title":"MELD 3.0 for adolescent liver transplant candidates.","volume":"78","author":"Kwong","year":"2023","journal-title":"Hepatology"},{"key":"B21","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1097\/LVT.0000000000000126","article-title":"Validation of MELD 3.0 scoring system in east Asian patients with cirrhosis awaiting liver transplantation.","volume":"29","author":"Yoo","year":"2023","journal-title":"Liver Transpl"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1837035\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:10:16Z","timestamp":1784286616000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1837035\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,17]]},"references-count":21,"alternative-id":["10.3389\/fmed.2026.1837035"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1837035","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,17]]},"article-number":"1837035"}}