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
ARTICLE HIGHLIGHTS
Research background

Hepatorenal syndrome (HRS) is a severe complication of cirrhosis with high mortality. It has a unique in vivo pathological environment compared with other end-stage liver diseases. Meanwhile, prognostic factors associated with prognosis of HRS are not rich enough, and current prognostic scoring systems for end-stage liver diseases need to be updated to fit the application in HRS.

Research motivation

As the diagnostic criteria for HRS were confusing before 2015, a multicenter retrospective study, strictly following the criteria proposed by the International Club of Ascites in 2015, was designed to systematically evaluate the evolution of HRS over the past decade at our institution and to figure out what affects the prognosis of HRS.

Research objectives

Our goal was to develop a novel scoring system to predict 28-d mortality of HRS and evaluate the accuracy, sensitivity, and specificity compared with other scoring systems, including 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.

Research methods

Demographic/clinical variables and medical records of HRS patients from January 2011 to October 2019 were collected from four tertiary medical centers, and strict eligibility criteria were applied. The final analysis included 371 patients with HRS. Univariate and multivariate Cox regression analyses were performed for prediction modeling of HRS.

Research results

We found that five indicators can be used as prognostic factors for HRS, including gender, international normalized ratio, mean corpuscular hemoglobin concentration, neutrophil percentage, and stage (defined as a binary variable by the number of failed organs). They formed a new score, GIMNS, based on the weight coefficient. As the GIMNS increases, the risk of mortality gets higher. The sensitivity and specificity of GIMNS were much higher than those of 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 in both the derivation and validation cohorts.

Research conclusions

We innovatively defined a new variable, stage (based on the number of failed organs), to predict the prognosis of HRS. Importantly, we developed a new scoring system, GIMNS, which was specifically for patients with HRS and performed better 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 in accuracy, sensitivity, and specificity. As the five prognostic factors in GIMNS are easily available, clinical application of GIMNS could be more convenient.

Research perspectives

The GIMNS scoring system should be validated in future prospective studies to get a more complete assessment.