Hepatitis B virus-related ACLF (HBV-ACLF) is a complicated syndrome with a high short-term mortality rate that develops in patients with HBV-related chronic liver disease, regardless of the presence of cirrhosis, and it is characterized by the acute deterioration of liver function and hepatic and/or extrahepatic organ failure. The short-term mortality rate is as high as 50-90%. The early prognosis of HBV-ACLF helps to optimize diagnostic and therapeutic schemes, thus improving the survival rate of patients.

To address the different clinical characteristics of ACLF patients in Eastern and Western populations, the research team led by Prof. LI Jun from the First Affiliated Hospital of Zhejiang University School of Medicine conducted a multi-center, prospective and open cohort study together with 13 famous liver disease centers in China. They developed the Chinese Group on the Study of Severe Hepatitis B-ACLF (COSSH-ACLF) criteria and the COSSH-ACLF score (COSSH-ACLFs) for HBV-ACLF, and revealed that the immune-metabolism disorder triggered by HBV exacerbation drives the development and progression of HBV-ACLF. These studies have been published in Gut (2018) and Gut (2021). The COSSH-ACLF criteria have been lauded as the second international standard with most case-based medical evidence in addition to the EASL-ACLF (European Association for the Study of the Liver) criteria.

On this basis, LI Jun et al. conducted a follow-up study on patients with acute deterioration of HBV-related chronic liver disease from the prospective open cohort of the COSSH study. Six predictive factors were significantly related to the 28-day mortality and constituted a new prognostic score (=1.649×ln(international normalized ratio)+0.457×hepatic encephalopathy score+0.425×ln(neutrophil)+0.396×ln(total bilirubin)+0.576×ln(serum urea)+0.033×age). The new prognostic score based on six predictors without an assessment of organ failure can accurately predict and easily stratify the short-term mortality of patients with HBV-ACLF and might be used for early prognosis to decrease the high mortality. This work was published in an article entitled “Development and validation of a new prognostic score for hepatitis B virus-related acute-on-chronic liver failure” in the Journal of Hepatology on June 3.