Abstract
BACKGROUND: Acute-on-chronic liver failure (ACLF) is a life-threatening hepatic syndrome. Therefore, this study aimed to develop a comprehensive model combining extracellular liver volume derived from spectral CT (ECV(IC-liver)) and sarcopenia, for the early prediction of short-term (90-day) disease progression in ACLF. MATERIALS AND METHODS: A retrospective cohort of 126 ACLF patients who underwent hepatic spectral CT scans was included. According to the Asia-Pacific Association for the Study of the Liver (APASL) criteria, patients were divided into the progression group (n = 70) and the stable group (n = 56). ECV(IC-liver) was measured on the equilibrium period (EP) images of spectral CT, and L3-SMI was measured on unenhanced CT images, with sarcopenia assessed. A comprehensive model was developed by combining independent predictors. Model performance was evaluated using receiver operating characteristic (ROC) curve analysis, calibration curves, and decision curve analysis (DCA). RESULTS: In the univariate analysis, BMI, WBC, PLT, PTA, L3-SMI, IC-EP, Z-EP, K(140)-EP, NIC-EP, ECV(IC-liver), and Sarcopenia demonstrated associations with disease progression status at 90 days in ACLF patients. In multivariate logistic regression, white blood cell count (WBC) (OR = 1.19, 95% CI: 1.02-1.40; P = 0.026), ECV(IC-liver) (OR = 1.27, 95% CI: 1.15-1.40; P < 0.001), sarcopenia (OR = 4.15, 95% CI: 1.43-12.01; P = 0.009), MELD-Na score (OR = 1.06, 95%CI: 1.01-1.13;P = 0.042), and CLIF-SOFA score (OR = 1.37, 95%CI:1.15-1.64; P<0.001) emerged as independent risk factors for ACLF progression. The combined model exhibited superior predictive performance (AUCs = 0.910, sensitivity = 80.4%, specificity = 90.0%, PPV = 0.865, NPV = 0.851) compared to CLIF-SOFA, MELD-Na, MELD and CTP scores(both P < 0.001). Calibration curves and DCA confirmed the high clinical utility of the combined model. CONCLUSIONS: Patients without sarcopenia and/or with a lower ECV(IC-liver) have a better prognosis, and the integration of WBC, ECV(IC-liver), Sarcopenia, CLIF-SOFA and MELD-Na scores in a composite model offers a concise and effective tool for predicting disease progression in ACLF patients. TRIAL REGISTRATION: Not Applicable.