Development and validation of a prognostic nomogram for decompensated liver cirrhosis

doi:10.12998/wjcc.v10.i29.10467

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World Journal of Clinical Cases

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Clin Cases. Oct 16, 2022; 10(29): 10467-10477
Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10467

Table 1 Participant characteristics

	Derivation cohort (n = 329)	Internal validation cohort (n = 164)	P
Age (yr), mean ± SD	53.76 ± 11.64	57.38 ± 11.89	0.001^a
Male sex, n (%)	253 (76.90)	116 (70.70)	0.137
Hospitalization period (d), mean ± SD	8.40 ± 5.88	9.49 ± 4.69	0.026^a
Liver cirrhosis etiology, n (%)
HBV	220 (66.90)	96 (58.50)	0.07
HCV	13 (3.95)	6 (3.66)	0.87
Alcoholic liver disease	52 (15.80)	30 (18.29)	0.49
Schistosomiasis cirrhosis	14 (4.25)	8 (4.88)	0.75
Primary biliary cirrhosis	3 (0.90)	5 (3.05)	0.08
Cryptogenic cirrhosis	27 (8.21)	18 (11.00)	0.31
Hospitalization reason, n (%)
Variceal bleeding	150 (45.60)	76 (46.34)	0.875
Hepatic encephalopathy	86 (26.14)	43 (26.22)	0.985
Infection	45 (13.68)	21 (12.80)	0.789
Ascites	28 (8.50)	13 (7.93)	0.825
Hepatorenal syndrome	20 (6.08)	11 (6.71)	0.787
Vasopressors	88 (26.75)	79 (48.17)	< 0.001^a
HBeAg (+)	35 (10.64)	15 (9.15)	0.605
Mechanical ventilation	18 (5.47)	36 (21.95)	< 0.001^a
Biochemical parameters
ALT, IU/L	22.00 (16.00-40.75)	29.00 (20.00-52.50)	< 0.001^a
AST, IU/L	44.00 (31.00-90.50)	39.00 (28.00-74.00)	0.085
GGT, IU/L	27.00 (15.00-74.50)	29.00 (14.00-79.50)	0.982
ALP, IU/L	73.70 (55.00-112.00)	82.50 (56.25-138.75)	0.037^a
Serum sodium, mmol/L	138.10 (135.00-141.00)	137.85 (134.03-140.98)	0.329
Creatinine, μmol/L	72.70 (59.35-93.20)	79.70 (63.55-115.00)	0.006^a
INR	1.32 (1.21-1.54)	1.45 (1.24-1.74)	< 0.001^a
Bilirubin, μmol/L	24.70 (15.80-42.80)	26.85 (16.03-58.25)	0.157
WBC, 10 × 9/L	6.39 (3.94-9.61)	6.81 (4.11-11.13)	0.11
Platelet, 10 × 9/L	74.50 (47.50-111.50)	73.80 (39.00-109.50)	0.245
PT, s	15.00 (13.80-17.20)	15.90 (13.40-19.20)	0.086
MAP, mmHg	83.00 (77.67-89.33)	82.17 (78.00-87.67)	0.472
PO₂/FiO₂	402.86 ± 118.57	388.28 ± 137.36	0.266
Albumin, g/L	28.41 ± 7.87	27.64 ± 6.18	0.256
CTP score	8 (7-10)	9 (7-11)	0.001^a
MELD score	9.44 (5.96-13.52)	12.20 (7.77-16.67)	< 0.001^a
Mortality, n (%)
28 d	41 (12.46)	47 (28.66)	< 0.001^a
3 mo	65 (19.76)	69 (42.07)	< 0.001^a
6 mo	75 (22.80)	73 (44.51)	< 0.001^a

^aSignificant P value.

HBV: Hepatitis B virus; HCV: Hepatitis B virus; HBeAg: Hepatitis Be antigen; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; INR: International normalized ratio; WBC: White blood cell; PT: Prothrombin time; MAP: Mean arterial blood pressure; PO₂/FiO₂: Arterial oxygen partial pressure/inhaled oxygen concentration; CTP score: Child-Turcotte-Pugh score; MELD score: Model for end-stage liver disease score.

Table 2 Univariate and multivariate Cox regression analyses in decompensated liver cirrhosis patients from the derivation cohort (n = 329)

	Univariate analysis		Multivariate analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Age	1.021 (1.001-1.040)	0.037^a	1.028 (1.007-1.050)	0.009^a
Male sex	1.133 (0.653-1.967)	0.657
Vasopressors
No	Reference
Yes	1.643 (1.027-2.628)	0.038^a
HBeAg
negative	Reference
positive	0.692 (0.301-1.594)	0.387
Mechanical ventilation
No	Reference
Yes	9.916 (5.486-17.922)	< 0.001^a	4.200 (1.975-8.932)	< 0.001^a
ALT	1.001 (1.000-1.002)	< 0.001^a
AST	1.001 (1.000-1.001)	< 0.001^a
GGT	1.001 (1.000-1.002)	0.090^a
ALP	1.002 (1.001-1.003)	< 0.001^a
Serum sodium	1.003 (0.982-1.026)	0.761
WBC	1.052 (1.030-1.073)	< 0.001^a
Platelet	1.002 (0.999-1.004)	0.259
MAP	0.976 (0.967-0.996)	0.019^a	0.979 (0.960-0.998)	0.031^a
PO₂/FiO₂	0.996 (0.994-0.998)	< 0.001^a	0.998 (0.995-1.000)	0.038^a
CTP score	1.332 (1.214-1.462)	< 0.001^a
MELD score	1.142 (1.107-1.178)	< 0.001^a	1.080 (1.030-1.132)	0.002^a

^aSignificant P value.

HBeAg: Hepatitis Be antigen; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase; ALP: Alkaline phosphatase; WBC: White blood cell; MAP: Mean arterial blood pressure; PO₂/FiO₂: Arterial oxygen partial pressure/inhaled oxygen concentration; CTP score: Child-Turcotte-Pugh score; MELD score: Model for end-stage liver disease score.

Table 3 The validation of the nomogram versus two scores by net reclassification index and integrated discrimination improvement index

Index	Derivation cohort			Validation cohort
	Estimate	95%CI	P value	Estimate	95%CI	P value
NRI versus CTP
For 28-d mortality	0.419	0.192-0.606	< 0.001^a	0.395	0.061-0.662	0.020^a
For 3-mo mortality	0.355	0.134-0.488	0.007^a	0.241	0.005-0.490	0.040^a
For 6-mo mortality	0.319	0.081-0.481	< 0.001^a	0.227	0.120-0.480	< 0.001^a
NRI vs MELD
For 28-d mortality	0.395	0.214-0.548	< 0.001^a	0.578	0.364-0.740	< 0.001^a
For 3-mo mortality	0.305	0.080-0.417	0.013^a	0.388	0.233-0.547	< 0.001^a
For 6-mo mortality	0.281	0.077-0.402	0.007^a	0.358	0.249-0.527	< 0.001^a
IDI vs CTP
For 28-d mortality	0.262	0.181-0.394	< 0.001^a	0.253	0.095-0.426	< 0.001^a
For 3-mo mortality	0.193	0.118-0.285	< 0.001^a	0.167	0.040-0.308	0.020^a
For 6-mo mortality	0.178	0.098-0.270	< 0.001^a	0.152	0.013-0.294	< 0.001^a
IDI vs MELD
For 28-d mortality	0.133	0.070-0.247	< 0.001^a	0.322	0.195-0.473	< 0.001^a
For 3-mo mortality	0.081	0.026-0.151	< 0.001^a	0.220	0.122-0.343	< 0.001^a
For 6-mo mortality	0.064	0.023-0.133	< 0.001^a	0.212	0.132-0.298	< 0.001^a

^aSignificant P value.

NRI: Net reclassification index; CTP: Child-Turcotte-Pugh; MELD: Model for end-stage liver disease; IDI: Integrated discrimination improvement index.

Citation: Zhang W, Zhang Y, Liu Q, Nie Y, Zhu X. Development and validation of a prognostic nomogram for decompensated liver cirrhosis. World J Clin Cases 2022; 10(29): 10467-10477
URL: https://www.wjgnet.com/2307-8960/full/v10/i29/10467.htm
DOI: https://dx.doi.org/10.12998/wjcc.v10.i29.10467