A novel prognostic model based on portal vein diameter for patients with acute-on-chronic liver failure

The prompt and accurate prognostication of acute-on-chronic liver failure (ACLF) patients is crucial for clinical intervention and reducing mortality. This study aimed to develop a novel prognostic model based on pathological changes, with a specific focus on portal vein which is correlated with hepatic pathology. A cohort of 127 ACLF patients was enrolled to develop the prognostic model for 90-day mortality, which was validated in a prospective cohort of 105 ACLF patients. Demographic characteristics, laboratory indicators, and imaging factor portal vein diameter (PVD) were screened, and a nomogram prognostic model was developed using logistic regression. Patients with PVD ≥ 13.4 mm had significantly higher mortality (P = 0.047). PVD, age, neutrophil percentage, sex and total bilirubin were identified as independent predictors for the new PVD-based nomogram prognostic model, PANST. The C-index (0.878) of PANST score was higher than Chronic Liver Failure-Consortium-ACLF (CLIF-C ACLF), end-stage liver disease (MELD) and Child-Turcotte-Pugh (CTP) scores (0.691, 0.687, 0.639, respectively; P < 0.001). The ROC and decision curves demonstrated that the PANST score was superior to CLIF-C ACLF, MELD and CTP scores. Furthermore, after subgroup analysis, the C-indices of PANST score for hepatitis B virus-related ACLF (HBV-ACLF) and non-HBV-ACLF patients (0.842,0.950) were significantly higher than those of CLIF-C ACLF score (0.772, 0.750; P < 0.05), MELD score (0.730, 0.608; all P < 0.05) and CTP score (0.701,0.513; all P < 0.05). These results were confirmed in the validation cohort. PVD was an independent predictor, and the PANST score, a novel prognostic model based on PVD can accurately predict 90-day mortality in ACLF patients.