Background: To evaluate the accuracy of two-dimensional (2D) shear wave elastography (SWE), develop and validate a novel prognostic model in predicting acute-on-chronic liver failure (ACLF) development in patients with acutely decompensated hepatitis B cirrhosis.
Methods: This prospective cohort study enrolled 221 patients in the First Affiliated Hospital of Nanchang University from September 2019 to January 2021, and randomly assigned them to the derivation and validation cohorts (7:3 ratio). Ultrasound, 2D SWE, clinical and laboratory data were collected, and outcome (ACLF developed) was recorded during a 90-day follow-up period. We evaluated the ability of 2D SWE to predict the outcome, developed a model for predicting ACLF development in the derivation cohort, and assessed the model in the validation cohort.
Results: 2D SWE values were significantly higher in patients with ACLF development (P<0.05). The accuracy of 2D SWE in predicting the outcome was better than that of serum parameters of liver fibrosis (all P<0.05). The SWE model for ACLF development had good calibration and discrimination [concordance index (C-index): 0.855 and 0.840 respectively] in derivation and validation cohorts, outperforming serum prognostic scores (all P<0.05).
Conclusions: The SWE model, superior to serum prognostic scores in predicting ACLF development, could be a noninvasive tool to guide the individual management of patients with acutely decompensated hepatitis B cirrhosis.
Keywords: Acute-on-chronic liver failure (ACLF); acute decompensation (AD); hepatitis B virus; shear wave elastography (SWE).
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