Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2022; 10(29): 10467-10477
Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10467
Development and validation of a prognostic nomogram for decompensated liver cirrhosis
Wang Zhang, Yue Zhang, Qi Liu, Yuan Nie, Xuan Zhu
Wang Zhang, Yue Zhang, Qi Liu, Yuan Nie, Xuan Zhu, Department of Gastroenterology, Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Zhang W and Zhang Y contributed equally to this study; Zhang W designed and wrote the original draft; Zhang Y collected the data and wrote the original draft; Liu Q analyzed the data; Nie Y and Zhu X critically revised the manuscript; All authors have read and approve the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81960120; the “Gan-Po Talent 555” Project of Jiangxi Province, No. GCZ (2012)-1; the Jiangxi Clinical Research Center for Gastroenterology, No. 20201ZDG02007.
Institutional review board statement: Study protocol was approved by the ethics committee of First Affiliated Hospital of Nanchang University (No.2013-1202). The study was performed in accordance with the Declaration of Helsinki.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Data sharing statement: The data that support the findings of this study are available from the corresponding author, Zhu X, upon reasonable request.
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: Xuan Zhu, MD, Professor, Department of Gastroenterology, Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, No.17 Yongwaizhengjie Road, Donghu District, Nanchang 330006, Jiangxi Province, China. waiyongtg@163.com
Received: May 30, 2022
Peer-review started: May 30, 2022
First decision: August 21, 2022
Revised: August 31, 2022
Accepted: September 9, 2022
Article in press: September 9, 2022
Published online: October 16, 2022
Processing time: 122 Days and 3.7 Hours
Abstract
BACKGROUND

Decompensated liver cirrhosis (DLC) is a stage in the progression of liver cirrhosis and has a high mortality.

AIM

To establish and validate a novel and simple-to-use predictive nomogram for evaluating the prognosis of DLC patients.

METHODS

A total of 493 patients with confirmed DLC were enrolled from The First Affiliated Hospital of Nanchang University (Nanchang, Jiangxi Province, China) between December 2013 and August 2019. The patients were divided into two groups: a derivation group (n = 329) and a validation group (n = 164). Univariate and multivariate Cox regression analyses were performed to assess prognostic factors. The performance of the nomogram was determined by its calibration, discrimination, and clinical usefulness.

RESULTS

Age, mechanical ventilation application, model for end-stage liver disease (MELD) score, mean arterial blood pressure, and arterial oxygen partial pressure/inhaled oxygen concentration were used to construct the model. The C-indexes of the nomogram in the derivation and validation groups were 0.780 (95%CI: 0.670-0.889) and 0.792 (95%CI: 0.698-0.886), respectively. The calibration curve exhibited good consistency with the actual observation curve in both sets. In addition, decision curve analysis indicated that our nomogram was useful in clinical practice.

CONCLUSION

A simple-to-use novel nomogram based on a large Asian cohort was established and validated and exhibited improved performance compared with the Child-Turcotte-Pugh and MELD scores. For patients with DLC, the proposed nomogram may be helpful in guiding clinicians in treatment allocation and may assist in prognosis prediction.

Keywords: Decompensated liver cirrhosis; Nomogram; Prognosis; Child-Turcotte-Pugh score; MELD score

Core Tip: The overall survival of decompensated liver cirrhosis (DLC) has been one of the main concerns of patients and clinicians. In this research, we established a simple and effective nomogram including age, application of mechanical ventilation, model for end-stage liver disease (MELD) score, mean arterial blood pressure and arterial oxygen partial pressure/inhaled oxygen concentration. This nomogram had better prognostic value than the Child-Turcotte-Pugh and MELD scores. Moreover, the nomogram was validated in the internal cohort, and it may be helpful in guiding clinicians in treatment allocation and in predicting the prognosis of DLC.