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 [PMID: 38855159 DOI: 10.3748/wjg.v30.i20.2657]
Corresponding Author of This Article
Li Liu, MD, Chief Physician, Department of Gastroenterology, The Second Hospital of Hebei Medical University, No. 215 West Road, Shijiazhuang 050000, Hebei Province, China. loraliu@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
World J Gastroenterol. May 28, 2024; 30(20): 2657-2676 Published online May 28, 2024. doi: 10.3748/wjg.v30.i20.2657
Development and validation of a new prognostic model for patients with acute-on-chronic liver failure in intensive care unit
Zong-Yi Zhu, Xiu-Hong Huang, Hui-Qing Jiang, Li Liu
Zong-Yi Zhu, Xiu-Hong Huang, Hui-Qing Jiang, Li Liu, Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Zong-Yi Zhu, Department of Gastroenterology, Weixian People's Hospital, Xingtai 054700, Hebei Province, China
Co-corresponding authors: Hui-Qing Jiang and Li Liu.
Author contributions: Zhu ZY analyzed the data and wrote the paper; Huang XH collected the data; Jiang HQ and Liu L designed the study and revised the paper; all authors have read and approved the final version. Jiang HQ and Liu L contributed equally to this work as co-corresponding authors. There are two reasons for designating Jiang HQ and Liu L as co-corresponding authors. First, this study was performed as a collaborative effort, and the designation of co-corresponding authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study and the resultant paper. This also ensures effective communication and handling of post-submission matters, ultimately enhancing the paper's quality and reliability. Second, Jiang HQ and Liu L contributed efforts of equal substance throughout the study process. The choice of these two researchers as co-corresponding authors acknowledges and respects this equal contribution, while recognizing the spirit of teamwork and collaboration of this study. In summary, we believe that designating Jiang HQ and Liu L as co-corresponding authors is fitting for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.
Institutional review board statement: MIMIC-Ⅳ and EICU are public databases in which all patients' private information is anonymous. Therefore, the approval for use of MIMIC-Ⅳ and EICU databases by local ethics committee was waived. This study was reviewed and approved by the SHHMU Institutional Review Board (Approval number: 2024-R230).
Informed consent statement: Informed consent from patients in the MIMIC-IV and EICU cohorts was obtained during the original data collection. Informed consent from patients in the SHHMU cohort was waived due to retrospective nature of this study.
Conflict-of-interest statement: The author declares that there is no conflict-of-interest.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li Liu, MD, Chief Physician, Department of Gastroenterology, The Second Hospital of Hebei Medical University, No. 215 West Road, Shijiazhuang 050000, Hebei Province, China. loraliu@163.com
Received: January 13, 2024 Revised: April 22, 2024 Accepted: May 9, 2024 Published online: May 28, 2024 Processing time: 133 Days and 2.6 Hours
Abstract
BACKGROUND
Cirrhotic patients with acute-on-chronic liver failure (ACLF) in the intensive care unit (ICU) have a poor but variable prognoses. Accurate prognosis evaluation can guide the rational management of patients with ACLF. However, existing prognostic scores for ACLF in the ICU environment lack sufficient accuracy.
AIM
To develop a new prognostic model for patients with ACLF in ICU.
METHODS
Data from 938 ACLF patients in the Medical Information Mart for Intensive Care (MIMIC) database were used to develop a new prognostic model (MIMIC ACLF) for ACLF. Discrimination, calibration and clinical utility of MIMIC ACLF were assessed by area under receiver operating characteristic curve (AUROC), calibration curve and decision curve analysis (DCA), respectively. MIMIC ACLF was then externally validated in a multiple-center cohort, the Electronic Intensive Care Collaborative Research Database and a single-center cohort from the Second Hospital of Hebei Medical University in China.
RESULTS
The MIMIC ACLF score was determined using nine variables: ln (age) × 2.2 + ln (white blood cell count) × 0.22 - ln (mean arterial pressure) × 2.7 + respiratory failure × 0.6 + renal failure × 0.51 + cerebral failure × 0.31 + ln (total bilirubin) × 0.44 + ln (internationalized normal ratio) × 0.59 + ln (serum potassium) × 0.59. In MIMIC cohort, the AUROC (0.81/0.79) for MIMIC ACLF for 28/90-day ACLF mortality were significantly greater than those of Chronic Liver Failure Consortium ACLF (0.76/0.74), Model for End-stage Liver Disease (MELD; 0.73/0.71) and MELD-Na (0.72/0.70) (all P < 0.001). The consistency between actual and predicted 28/90-day survival rates of patients according to MIMIC ACLF score was excellent and superior to that of existing scores. The net benefit of MIMIC ACLF was greater than that achieved using existing scores within the 50% threshold probability. The superior predictive accuracy and clinical utility of MIMIC ACLF were validated in the external cohorts.
CONCLUSION
We developed and validated a new prognostic model with satisfactory accuracy for cirrhotic patients with ACLF hospitalized in the ICU. The model-based risk stratification and online calculator might facilitate the rational management of patients with ACLF.
Core Tip: Patients with acute-on-chronic liver failure (ACLF) usually need to be hospitalized in intensive care unit for condition monitoring and organ support therapy where existing prognostic scores for ACLF have a limited predictive accuracy. In this study, we developed a new prognostic model [Medical Information Mart for Intensive Care (MIMIC) ACLF] using data in MIMIC database for patients with ACLF. MIMIC ACLF not only exhibited a satisfactory predictive accuracy and clinical utility in MIMIC cohort, but also performed well in external single and multiple-center validation cohorts. In addition, we performed a risk stratification and developed an online calculator based on MIMIC ACLF to facilitate its application in clinical practice.
