Chen Jie, Luo Sha, Tang Feng, Han Ming, Zheng Jie, Deng Mingming, Luo Gang
Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
Department of Laboratory Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
Ann Hepatol. 2023 May-Jun;28(3):101086. doi: 10.1016/j.aohep.2023.101086. Epub 2023 Mar 6.
Cirrhotic patients with acute variceal hemorrhage (AVH) have high short-term mortality. Established prognostic scores are seldom applicable clinically, partially because they need external validation or contain subjective variables. We aimed to develop and validate a practical prognostic nomogram based on objective predictors to predict prognosis for cirrhotic patients with AVH.
We enrolled 308 AVH patients with cirrhosis from our center as the derivation cohort to develop a new nomogram using logistic regression and validated it in cohorts of patients from Medical Information Mart for Intensive Care (MIMIC) III (n = 247) and IV (n = 302).
International normalized ratio (INR), albumin (ALB) and estimated glomerular filtration rate (eGFR) were identified as predictors for inpatient mortality and a nomogram was constructed based on them. The nomogram discriminated well in both derivation and MIMIC-III/-IV validation cohorts with the area under the receiver operating characteristic curves (AUROCs) of 0.846 and 0.859/0.833, respectively and showed a better agreement between expected and observed outcomes (Hosmer-Lemeshow tests, all comparisons, P > 0.05) than other scores in all cohorts. Our nomogram had the lowest Brier scores (0.082/0.114/0.119 in training/MIMIC-III/MIMIC-IV) and highest R (0.367/0.393/0.346 in training/MIMIC-III/MIMIC-IV) compared to the recalibrated model for end-stage liver disease (MELD), MELD-hepatic encephalopathy (MELD-HE) and cirrhosis acute gastrointestinal bleeding (CAGIB) scores in all cohorts.
We developed a practical prognostic nomogram using easily verified indicators available in initial patient evaluation, which may serve as a reliable tool to accurately predict inpatient mortality for cirrhotic patients with AVH.
肝硬化合并急性静脉曲张出血（AVH）的患者短期死亡率很高。现有的预后评分在临床中很少适用，部分原因是它们需要外部验证或包含主观变量。我们旨在开发并验证一种基于客观预测指标的实用预后列线图，以预测肝硬化合并AVH患者的预后。
我们纳入了本中心308例肝硬化合并AVH的患者作为推导队列，使用逻辑回归开发了一种新的列线图，并在重症监护医学信息数据库（MIMIC）III（n = 247）和IV（n = 302）的患者队列中进行了验证。
国际标准化比值（INR）、白蛋白（ALB）和估算肾小球滤过率（eGFR）被确定为住院死亡率的预测指标，并据此构建了列线图。该列线图在推导队列以及MIMIC-III/-IV验证队列中均表现出良好的区分能力，受试者工作特征曲线下面积（AUROC）分别为0.846和0.859/0.833，并且在所有队列中，与其他评分相比，预期结果与观察结果之间的一致性更好（Hosmer-Lemeshow检验，所有比较，P>0.05）。与重新校准的终末期肝病模型（MELD）、MELD-肝性脑病（MELD-HE）和肝硬化急性胃肠道出血（CAGIB）评分相比，我们的列线图在所有队列中的Brier评分最低（训练/MIMIC-III/MIMIC-IV中分别为0.082/0.114/0.119），R最高（训练/MIMIC-III/MIMIC-IV中分别为0.367/0.393/0.346）。
我们使用初始患者评估中易于验证的指标开发了一种实用的预后列线图，它可作为准确预测肝硬化合并AVH患者住院死亡率的可靠工具。
