Development and validation of a new prognostic model for patients with acute-on-chronic liver failure in intensive care unit

doi:10.3748/wjg.v30.i20.2657

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May 28, 2024 (publication date) through Jun 29, 2024

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World Journal of Gastroenterology

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1007-9327

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Retrospective Cohort Study

World J Gastroenterol. May 28, 2024; 30(20): 2657-2676
Published online May 28, 2024. doi: 10.3748/wjg.v30.i20.2657

Table 1 Baseline characteristics of patients with Acute-on-chronic liver failure in different cohorts

Baseline characteristics	MIMIC cohort		External validation cohorts
Baseline characteristics	Derivation set (n = 938)	Validation set (n = 313)	eICU (n = 551)	SHHMU (n = 121)
Age (yr)	59 (52-68)	56 (53-66)	57 (50-64)	58 ± 13
Male, n (%)	617 (65.8)	202 (64.5)	334 (60.6)	81 (66.9)
Race, n (%)
White	613 (65.4)^a	209 (66.8)	448 (81.3)	Eastern Asian
Non white	325 (34.6)^a	104 (33.2)	103 (18.7)	Eastern Asian
Etiology of cirrhosis, n (%)
Alcohol	524 (55.9)^b	180 (57.5)	376 (68.2)	43 (35.5)
Non-alcohol	414 (44.1)^b	133 (42.5)	175 (31.8)	78 (64.5)
AD at admission, n (%)
Ascites	520 (55.4)^a^,^b	173 (55.3)	169 (30.7)	32 (26.4)
Hepatic encephalopathy	390 (41.6)^b	136 (43.5)	156 (28.3)	31 (25.6)
Bacterial infection	422 (45.0)^b	152 (48.6)	216 (39.2)	16 (13.2)
Acute variceal bleeding	75 (8.0)^a^,^b	34 (10.9)	127 (23.0)	42 (34.7)
Laboratory indicators
WBC (10⁹/L)	12 (8-18)^b	13 (9-18)	10 (6-14)	6 (5-11)
Hemoglobin	85 (73-100)^b	83 (72-98)	88 (75-103)	92 (77-107)
Platelet (10⁹/L)	81 (50-135)	72 (49-120)	78 (49-126)	75 (48-116)
Total bilirubin (mg/dL)	4.1 (1.6-11.7)	4.9 (1.8-12.3)	4.0 (1.5-12.9)	6.2 (1.6-17.5)
Albumin (g/dL)	2.9 (2.4-3.3)	2.9 (2.4-3.4)	2.8 (2.2-3.3)	2.9 ± 0.6
ALT (U/L)	39 (22-98)^b	39 (23-101)	36 (21-97)	34 (16-64)
AST (U/L)	83 (44-216)^b	94 (47-266)	91 (43-253)	62 (35-138)
INR	2.1 (1.6-2.8)^a^,^b	2.0 (1.6-2.7)	1.7 (1.4-2.4)	1.7 (1.2-2.6)
Prothrombin time (s)	22 (17-30)^b	22 (17-29)	21 (16-28)	19 (14-29)
Serum creatinine (mg/dL)	2.1 (1.3-3.4)	2.0 (1.2-3.2)	2.0 (1.1-3.2)	2.1 (1.1-3.0)
Serum sodium (mEq/L)	135 (131-139)	135 (131-139)	137 (133-142)	134 ± 7
Serum potassium (mEq/L)	4.6 (4.1-5.3)^a^,^b	4.6 (4.2-5.4)	4.0 (3.6-4.6)	4.2 (3.7-4.7)
Organ failure, n (%)
Circulatory failure	382 (40.7)^a^,^b	148 (47.3)	305 (55.4)	18 (14.9)
Respiratory failure	427 (45.5)^a^,^b	156 (49.8)	162 (29.4)	22 (18.2)
Cerebral failure	129 (13.8)^a^,^b	46 (14.7)	223 (40.5)	38 (31.4)
Renal failure	658 (70.1)^a^,^b	201 (64.2)	280 (50.8)	75 (62.0)
Coagulation failure	332 (35.4)^b	106 (33.9)	131 (23.8)	37 (30.6)
Liver failure	233 (24.8)^a^,^b	82 (26.2)	273 (49.5)	54 (44.6)
Prognostic scores at admission
MELD	28 (22-34)^a^,^b	27 (21-34)	25 ± 10	25 (18-31)
MELD-Na	31 (23-40)^b	31 (22-40)	27 (19-35)	30 (21-38)
CLIF-C ACLF	58 (51-64)^b	58 (52-64)	50 (45-57)	47 (42-54)
Liver transplantation, n (%)	44 (4.7)	11 (3.5)	24 (4.4)	2 (1.7)
ACLF grade, n (%)
Grade 1	266 (28.4)^a	86 (27.5)	263 (46.3)	30 (33.1)
Grade 2	317 (33.8)	105 (33.5)	177 (31.1)	50 (41.3)
Grade 3	355 (37.8)^a	122 (39.0)	128 (22.6)	41 (33.9)
28-day mortality, n (%)	376 (40.1)	122 (39.0)	--	46 (38.0)
90-day mortality, n (%)	465 (49.6)	144 (46.0)	--	59 (48.7)
In-ICU mortality, n (%)	--	--	112 (20.3)	--
In-hospital mortality, n (%)	--	--	179 (32.4)	--

^aP < 0.05 vs electronic intensive care unit cohort.

^bP < 0.05 vs the Second Hospital of Hebei Medical University cohort.

Data were described as means ± SD, median (interquartile range) or number (percentage) of patients and compared by Kruskal-Wallis test and chi-square test where appropriate. AD: Acute decompensation; ACLF: Acute-on-chronic liver failure; INR: International normalized ratio; MIMIC: Medical Information Mart for Intensive Care; MELD: Model for End-stage Liver; CLIF-C: Chronic Liver Failure Consortium; eICU: Electronic intensive care unit; ICU: Intensive care unit; SHHMU: The Second Hospital of Hebei Medical University; WBC: White blood cell; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase.

Citation: Zhu ZY, Huang XH, Jiang HQ, Liu L. Development and validation of a new prognostic model for patients with acute-on-chronic liver failure in intensive care unit. World J Gastroenterol 2024; 30(20): 2657-2676
URL: https://www.wjgnet.com/1007-9327/full/v30/i20/2657.htm
DOI: https://dx.doi.org/10.3748/wjg.v30.i20.2657