Copyright
©The Author(s) 2024.
World J Gastroenterol. May 28, 2024; 30(20): 2657-2676
Published online May 28, 2024. doi: 10.3748/wjg.v30.i20.2657
Published online May 28, 2024. doi: 10.3748/wjg.v30.i20.2657
Baseline characteristics | MIMIC cohort | External validation cohorts | ||
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) | -- |
Variable | Univariate analysis | Multivariate analysis | ||
HR (95%CI) | P value | HR (95%CI) | P value | |
Female | 1.08 (0.88-1.33) | 0.47 | ||
Ln (age) | 2.18 (1.32-3.61) | 0.002 | 9.14 (5.16-16.19) | < 0.001 |
Race (Non-white) | 1.15 (0.93-1.41) | 0.20 | ||
Cirrhosis etiology (non-alcohol) | 1.00 (0.82-1.23) | 0.998 | ||
Ln (MAP) | 0.03 (0.01-0.06) | < 0.001 | 0.06 (0.03-0.14) | < 0.001 |
Organ failures | ||||
Circulatory failure | 1.87 (1.53-2.29) | < 0.001 | ||
Respiratory failure | 1.56 (1.27-1.93) | < 0.001 | 1.84 (1.48-2.29) | < 0.001 |
Cerebral failure | 1.63 (1.26-2.11) | < 0.001 | 1.36 (1.05-1.77) | 0.02 |
Renal failure | 1.89 (1.53-2.34) | < 0.001 | 1.68 (1.36-2.09) | < 0.001 |
Liver failure | 2.31 (1.67-2.50) | < 0.001 | ||
Coagulation failure | 2.04 (1.87-2.84) | < 0.001 | ||
Laboratory indicators | ||||
Ln (WBC) | 1.58 (1.33-1.88) | < 0.001 | 1.25 (1.05-2.10) | 0.01 |
Ln (hemoglobin) | 0.65 (0.44-0.97) | 0.04 | ||
Ln (platelet) | 0.84 (0.73-0.97) | 0.02 | ||
Ln (TB) | 1.50 (1.38-1.63) | < 0.001 | 1.57 (1.42-1.73) | < 0.001 |
Ln (Albumin) | 0.68 (0.45-1.04) | 0.07 | ||
Ln (ALT) | 1.04 (0.97-1.12) | 0.29 | ||
Ln (AST) | 1.09 (1.02-1.17) | 0.01 | ||
Ln (INR) | 1.27 (1.20-1.33) | < 0.001 | 1.82 (1.43-2.32) | < 0.001 |
Ln (sodium) | 0.04 (0.01-0.23) | < 0.001 | ||
Ln (potassium) | 2.05 (1.23-3.41) | 0.006 | 1.84 (1.10-3.07) | 0.02 |
Scores | Youden index | Cutoff value | SEN (%) | SPE (%) | PPV (%) | NPV (%) | Brier score | R2 value | P in H-L test |
Derivation set in MIMIC cohort | Development of MIMIC ACLF score | ||||||||
MIMIC ACLF | 0.48 | 0.57 | 71.81 | 75.98 | 66.7 | 80.1 | 0.17 | 0.36 | 0.73 |
CLIF-C ACLF | 0.40 | 59 | 65.43 | 74.56 | 63.2 | 76.3 | 0.19 | 0.26 | 0.70 |
MELD | 0.38 | 27 | 73.14 | 65.12 | 58.4 | 78.4 | 0.20 | 0.20 | 0.04 |
MELD-Na | 0.36 | 29 | 75.53 | 59.96 | 55.8 | 78.6 | 0.21 | 0.18 | 0.11 |
Validation set in MIMIC cohort | Internal validation | ||||||||
MIMIC ACLF | 0.46 | 0.32 | 81.97 | 64.40 | 69.5 | 84.8 | 0.17 | 0.36 | 0.26 |
CLIF-C ACLF | 0.40 | 61 | 55.74 | 84.29 | 69.4 | 74.9 | 0.19 | 0.26 | 0.92 |
MELD | 0.37 | 27 | 72.13 | 64.40 | 56.4 | 78.3 | 0.20 | 0.21 | 0.67 |
MELD-Na | 0.35 | 30 | 72.95 | 62.30 | 55.3 | 78.3 | 0.20 | 0.23 | 0.09 |
SHHMU cohort | External validation | ||||||||
MIMIC ACLF | 0.49 | 1.51 | 65.22 | 84.00 | 71.4 | 79.7 | 0.17 | 0.34 | 0.84 |
CLIF-C ACLF | 0.54 | 49 | 71.74 | 82.67 | 71.7 | 82.7 | 0.17 | 0.35 | 0.14 |
MELD | 0.30 | 33 | 36.96 | 93.33 | 77.3 | 70.7 | 0.21 | 0.13 | 0.08 |
MELD-Na | 0.44 | 34 | 60.87 | 82.67 | 68.3 | 77.5 | 0.20 | 0.22 | 0.52 |
- 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