DataSheet_1_A multi-subgroup predictive model based on clinical parameters and laboratory biomarkers to predict in-hospital outcomes of plasma exchange-centered artificial liver treatment in patients with hepatitis B virus-related acute-on-chronic liver failure.docx

BackgroundPostoperative risk stratification is challenging in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) who undergo artificial liver treatment. This study characterizes patients’ clinical parameters and laboratory biomarkers with different in-hospital outcomes. The purpose was to establish a multi-subgroup combined predictive model and analyze its predictive capability.MethodsWe enrolled HBV-ACLF patients who received plasma exchange (PE)-centered artificial liver support system (ALSS) therapy from May 6, 2017, to April 6, 2022. There were 110 patients who died (the death group) and 110 propensity score-matched patients who achieved satisfactory outcomes (the survivor group). We compared baseline, before ALSS, after ALSS, and change ratios of laboratory biomarkers. Outcome prediction models were established by generalized estimating equations (GEE). The discrimination was assessed using receiver operating characteristic analyses. Calibration plots compared the mean predicted probability and the mean observed outcome.ResultsWe built a multi-subgroup predictive model (at admission; before ALSS; after ALSS; change ratio) to predict in-hospital outcomes of HBV-ACLF patients who received PE-centered ALSS. There were 110 patients with 363 ALSS sessions who survived and 110 who did not, and 363 ALSS sessions were analyzed. The univariate GEE models revealed that several parameters were independent risk factors. Clinical parameters and laboratory biomarkers were entered into the multivariate GEE model. The discriminative power of the multivariate GEE models was excellent, and calibration showed better agreement between the predicted and observed probabilities than the univariate models.ConclusionsThe multi-subgroup combined predictive model generated accurate prognostic information for patients undergoing HBV-ACLF patients who received PE-centered ALSS.</p

The value of grip test, lysophosphatidlycholines, glycerophosphocholine, ornithine, glucuronic acid decrement in assessment of nutritional and metabolic characteristics in hepatitis B cirrhosis

<div><p>The liver is essential for the regulation of energy, protein and amino acids, as well as in other aspects of metabolism. To identify efficient indexes for evaluation of nutritional status and metabolic characteristics during different Child-Pugh stages of hepatitis B cirrhosis, 83 patients and 35 healthy individuals were enrolled in our study. We found that grip strength, triceps skinfold thickness (TSF), body fat and skeletal muscle of the patients were reduced compared to the control group (<i>P</i><0.05). Ultra-high-performance liquid chromatography data combined with mass spectrometry (UPLC-MS) showed that levels of a variety of metabolites, including lysophosphatidylcholines (LysoPCs), glycerophosphocholine, ornithine and glucuronic acid were reduced in the serum of patients with hepatitis B cirrhosis (<i>P</i><0.001). However, glycerophosphoserine and taurocholic acid levels were higher than in the control group (<i>P</i><0.001). Moreover, grip strength was correlated with the Child-Pugh score (<i>P</i><0.05). Serum albumin, total cholesterol, LDL, LysoPCs, glycerophosphocholine, ornithine, glucuronic acid, glycerophosphoserine and taurocholic acid were correlated with the Child-Pugh score (<i>P</i><0.01). These findings suggested that grip strength and the above small molecular substances might be considered as sensitive and important indexes for evaluating nutritional status and metabolic characteristics of patients with hepatitis B cirrhosis, which may help assess prognosis and adjust nutritional treatment.</p></div

Correlation between each index and the Child-Pugh score.

<p>Correlation between each index and the Child-Pugh score.</p

Extraction ion chromatography peak integral area of the characteristic metabolites.

<p>Extraction ion chromatography peak integral area of the characteristic metabolites.</p

Indexes of anthropometry and body composition analysis in the case groups and control group.

<p>Indexes of anthropometry and body composition analysis in the case groups and control group.</p

The principal component (PCA) model of the serum samples from patients with hepatitis B cirrhosis and normal controls.

<p>A: Child-Pugh A group; B: Child-Pugh B group; C: Child-Pugh C group. Normal: Control group.</p

The orthogonal partial least squares discriminant analysis (OPLS-DA) model of patients with hepatitis B cirrhosis and the normal control group serum samples.

<p>A: Child-Pugh A group; B: Child-Pugh B group; C: Child-Pugh C group. Normal: Control group. In the second prediction of principal component orientation (Y axis), the serum metabolic profile of patients with different stages of cirrhosis of the liver can be distinguished by clustering. The second prediction of principal component orientation represents the development trend of hepatitis B cirrhosis.</p