Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2021; 27(20): 2615-2629
Published online May 28, 2021. doi: 10.3748/wjg.v27.i20.2615
Development and validation of a prognostic model for patients with hepatorenal syndrome: A retrospective cohort study
Xin-Yu Sheng, Fei-Yan Lin, Jian Wu, Hong-Cui Cao
Xin-Yu Sheng, Fei-Yan Lin, Jian Wu, Hong-Cui Cao, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
Xin-Yu Sheng, Fei-Yan Lin, Jian Wu, Hong-Cui Cao, National Clinical Research Center for Infectious Diseases, Hangzhou 310003, Zhejiang Province, China
Author contributions: Sheng XY designed the research study, collected data, and wrote the manuscript; Lin FY and Wu J contributed to the analysis, conception, design, and manuscript writing; and Cao HC contributed to the design, study supervision, and manuscript writing; All authors read and approved the final manuscript.
Supported by Chinese High Tech Research & Development (863) Program, No. 2013AA020102.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of The First Affiliated Hospital, College of Medicine, Zhejiang University (No. 2019-1449-1).
Informed consent statement: The researchers only analyzed anonymous data, so informed consent was waived.
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Cui Cao, MD, PhD, Professor, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310003, Zhejiang Province, China. hccao@zju.edu.cn
Received: November 13, 2020
Peer-review started: November 13, 2020
First decision: February 11, 2021
Revised: February 23, 2021
Accepted: April 8, 2021
Article in press: April 8, 2021
Published online: May 28, 2021
Processing time: 188 Days and 4.7 Hours
Abstract
BACKGROUND

Hepatorenal syndrome (HRS) is a severe complication of cirrhosis with high mortality, which necessitates accurate clinical decision. However, studies on prognostic factors and scoring systems to predict overall survival of HRS are not enough. Meanwhile, a multicenter cohort study with a long span of time could be more convincing.

AIM

To develop a novel and effective prognostic model for patients with HRS and clarify new prognostic factors.

METHODS

We retrospectively enrolled 1667 patients from four hospitals, and 371 eligible patients were finally analyzed to develop and validate a novel prognostic model for patients with HRS. Characteristics were compared between survivors and non-survivors, and potential prognostic factors were selected according to the impact on 28-d mortality. Accuracy in predicting 28-d mortality was compared between the novel and other scoring systems, including Model for End-Stage Liver Disease (MELD), Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), and Chinese Group on the Study of Severe Hepatitis B-Acute-on-Chronic Liver Failure (COSSH-ACLF).

RESULTS

Five prognostic factors, comprised of gender, international normalized ratio, mean corpuscular hemoglobin concentration, neutrophil percentage, and stage, were integrated into a new score, GIMNS; stage is a binary variable defined by the number of failed organs. GIMNS was positively correlated with MELD, CLIF-SOFA, and COSSH-ACLF. Additionally, it had better accuracy [area under the receiver operating characteristic curve (AUROC): 0.830] than MELD (AUROC: 0.759), CLIF-SOFA (AUROC: 0.767), and COSSH-ACLF (AUROC: 0.759) in the derivation cohort (P < 0.05). It performed better than MELD and CLIF-SOFA in the validation cohort (P < 0.050) and had a higher AUROC than COSSH-ACLF (P = 0.122).

CONCLUSION

We have developed a new scoring system, GIMNS, to predict 28-d mortality of HRS patients. Mean corpuscular hemoglobin concentration and stage were first proposed and found to be related to the mortality of HRS. Additionally, the GIMNS score showed better accuracy than MELD and CLIF-SOFA, and the AUROC was higher than that of COSSH-ACLF.

Keywords: Hepatorenal syndrome; Prognostic factor; Mean corpuscular hemoglobin concentration; Mortality; Scoring system; Cohort study

Core Tip: This multicenter retrospective cohort study investigated the prognostic factors for patients with hepatorenal syndrome and developed a novel prognostic model, named GIMNS. GIMNS contains five prognostic factors, comprised of gender, international normalized ratio, mean corpuscular hemoglobin concentration, neutrophil percentage, and stage, which had different expression levels between survivors and non-survivors. Stage, defined according to the number of organ failures and mean corpuscular hemoglobin concentration, was found to be an effective prognostic factor for the first time. The area under the operating characteristic curve reached 0.830 for 28-d mortality. The GIMNS score showed better accuracy than Model for End-Stage Liver Disease, Chronic Liver Failure-Sequential Organ Failure Assessment, and Chinese Group on the Study of Severe Hepatitis B-Acute-on-Chronic Liver Failure.