State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, China.
Department of Gastroenterology, Lishui People's Hospital, Lishui, 323000, China.
BMC Gastroenterol. 2024 Nov 14;24(1):408. doi: 10.1186/s12876-024-03494-3.
Decompensated cirrhosis (DC) is prone to recurrent episodes of decompensation following the initial event. This study aimed to identify the risk factors for subsequent decompensation and assess their impact on the outcomes of patients hospitalized for DC.
Patients with DC were divided into two groups based on the occurrence of new decompensated events during hospitalization. Logistic regression analysis was employed to identify risk factors for new decompensation. The Cox proportional hazards model was used to evaluate the relationship between new decompensation and short-term mortality risk in these patients.
The study cohort consisted of 339 patients with DC, with a median age of 57 years. During hospitalization, 83 patients (24.5%) experienced new decompensated events, with bacterial infections (BIs) being the most common (n = 46, 13.6%). Multivariate analysis revealed that the Model for End-Stage Liver Disease (MELD) score at admission (OR = 1.06, 95% CI: 1.02-1.11, P = 0.005) was the sole risk factor for new decompensation during hospitalization. Patients who experienced new decompensation had significantly higher 28-day (28.9% vs. 7.0%, P < 0.001) and 90-day (33.7% vs. 15.2%, P < 0.001) transplant-free mortality compared to those who did not. After adjusting for white cell count, C-reactive protein, and MELD score, new decompensation during hospitalization was identified as an independent risk factor for 28-day and 90-day mortality (HR = 2.63, 95% CI: 1.42-4.87, P = 0.002 and HR = 1.73, 95% CI: 1.04-2.88, P = 0.033, respectively).
Patients with high MELD scores are susceptible to new decompensation during hospitalization, and the occurrence of new decompensation adversely affects short-term mortality in patients with DC.
失代偿性肝硬化（DC）在首次发作后容易反复出现失代偿事件。本研究旨在确定随后发生失代偿的危险因素，并评估其对因 DC 住院患者结局的影响。
根据住院期间是否发生新的失代偿事件，将 DC 患者分为两组。采用 Logistic 回归分析确定新失代偿的危险因素。采用 Cox 比例风险模型评估新失代偿与这些患者短期死亡率风险之间的关系。
研究队列包括 339 例 DC 患者，中位年龄为 57 岁。住院期间，83 例（24.5%）患者发生新的失代偿事件，其中细菌感染（BI）最常见（n=46，13.6%）。多变量分析显示，入院时终末期肝病模型（MELD）评分（OR=1.06，95%CI：1.02-1.11，P=0.005）是住院期间新发失代偿的唯一危险因素。发生新失代偿的患者 28 天（28.9%比 7.0%，P<0.001）和 90 天（33.7%比 15.2%，P<0.001）无移植死亡率显著更高。在校正白细胞计数、C 反应蛋白和 MELD 评分后，住院期间新发失代偿被确定为 28 天和 90 天死亡率的独立危险因素（HR=2.63，95%CI：1.42-4.87，P=0.002 和 HR=1.73，95%CI：1.04-2.88，P=0.033）。
MELD 评分较高的患者易在住院期间发生新的失代偿，新失代偿的发生对 DC 患者的短期死亡率有不利影响。
