Derivation and external validation of a model to predict 2-year mortality risk of patients with advanced schistosomiasis after discharge.

To date, no risk prediction tools have been developed to identify high mortality risk of patients with advanced schistosomiasis within 2 years after discharge. We aim to derive and validate a risk prediction model to be applied in clinical practice. The risk prediction model was derived from 1487 patients from Jingzhou and externally validated by 723 patients of Huangshi, two prefecture-level cities in Hubei province, China (from September 2014 to January 2015, with follow-up to January 2017). The baseline variables were collected. The mean age [SD] was 62.89 [10.38] years for the derivation cohort and 62.95 [12.22] years for the external validation cohort. The females accounted for 36.3% and 43.7% of the derivation and validation cohorts, respectively. 8.27% patients (123/1487) in the derivation cohort and 7.75% patients (56/723) in the external validation cohort died within 2 years after discharge. We constructed 4 models based on the 7 selected variables: age, clinical classification, serum direct bilirubin (DBil), aspartate aminotransferase (AST), alkaline phosphatase (ALP), hepatitis B surface antigen (HBsAg), alpha fetoprotein (AFP) at admission. In the external validation cohort, the multivariate model including 7 variables had a C statistic of 0.717 (95% CI, 0.646-0.788) and improved integrated discrimination improvement (IDI) value and net reclassification improvement (NRI) value compared to the other reduced models. Therefore, a multivariate model was developed to predict the 2-year mortality risk for patients with advanced schistosomiasis after discharge. It could also help guide follow-up, aid prognostic assessment and inform resource allocation.