A risk scoring system to predict clinical events in chronic hepatitis B virus infection: a nationwide cohort study
Ae Jeong Jo 1 , Won-Mook Choi 2 , Hyo Jeong Kim 1 , So Hyun Choi 1 3 , Seungbong Han 4 , Min Jung Ko 1 , Young-Suk Lim 2
Affiliations
Affiliations
1
Division for Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea.
2
Liver Center, Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
3
Department of Statistics, Kyungpook National University, Daegu, Republic of Korea.
4
Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea.
PMID: 34762757 DOI: 10.1111/jvh.13631
Abstract
Many patients with chronic hepatitis B do not receive adequate follow-up. This study aimed to develop a risk score to predict clinical events in patients with chronic hepatitis B virus (HBV) infection at the population level for identifying patients at high-risk to warrant regular follow-up. This study analyzed population-based data from the nationwide claims database of South Korea obtained between 2005 and 2015. We identified 507,239 non-cirrhotic patients with chronic HBV infection who are not under antiviral treatment. A risk score for predicting clinical events (hepatocellular carcinoma, death, or liver transplantation) was developed based on multivariable Cox proportional hazard model in a development cohort (n = 401,745) and validated in a validation cohort (n = 105,494). The cumulative incidence rates of clinical events at 5 years were 2.56% and 2.44% in the development and validation cohorts, respectively. Clinical events in Asymptomatic Patients with chronic HBV infection (CAP-B) score ranging from 0 to 7.5 points based on age, sex, socioeconomic status, chronic hepatitis C co-infection, diabetes mellitus, statin or antiplatelet exposure, smoking, alcohol consumption, alanine aminotransferase, and gamma-glutamyltransferase had good discriminatory accuracy in both the development and validation cohorts (c-indices for 3-, 5-, 10-year risk prediction: all 0.786). The predicted and observed probabilities of clinical events were calibrated in both cohorts. A score of >3.5 points identified subjects at distinctly high risk. The CAP-B score using easily accessible variables can predict clinical events and may allow selection of patients with chronic HBV infection for priority of regular follow-up.
Keywords: Death; Hepatocellular carcinoma; Liver transplantation; National Health Insurance Database; Risk prediction.
This article is protected by copyright. All rights reserved.