Dewi Ni Nyoman Gita Kharisma, Mariadi I Ketut, Dewi Ni Luh Putu Yunia, Pamungkas Kadek Mercu Narapati, Dewi Putu Itta Sandi Lesmana, Sindhughosa Dwijo A
Division of Gastroenterology and Hepatology, Centre Research for Alimentary and Hepatobiliary System, Denpasar, IDN.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Udayana University, Denpasar, IDN.
Cureus. 2025 Mar 30;17(3):e81446. doi: 10.7759/cureus.81446. eCollection 2025 Mar.
Background Liver cirrhosis (LC) is characterized by the development of fibrosis and nodules within the liver, leading to progressive liver dysfunction. The mortality rate associated with LC has consistently remained high over the years. Prognostic tools such as the Child-Turcotte-Pugh (CTP) score and the Model for End-Stage Liver Disease (MELD) score are commonly used to predict mortality and assess the severity of LC. Both scoring systems rely on laboratory parameters, including serum albumin, total bilirubin, and international normalized ratio (INR) levels. However, the CTP score interpretation can be variable, and INR testing is not routinely performed in many clinical settings, which may limit its utility. This study aims to assess the MELD and CTP scores, along with a new predictive tool, in estimating 30-day mortality for patients with LC. Methodology This retrospective cohort study focuses on patients diagnosed with LC at Ngoerah Central General Hospital. Physical examination data and laboratory ratios, including neutrophil-to-lymphocyte ratio (NLR), aspartate transaminase (AST) to alanine transaminase (ALT) ratio (de Ritis), neutrophil-to-lymphocyte-to-albumin (NLA) ratio, albumin bilirubin index (ALBI), and blood urea nitrogen-to-albumin ratio (BAR), were collected from medical records. Optimal cutoff values were established using receiver operating characteristic (ROC) curves. Survival analysis was performed using the Kaplan-Meier method, and multivariate Cox regression was employed to determine the hazard ratio (HR) for each variable that was statistically significant as a predictor of 30-day mortality. Results In this study, a total of 140 samples were analyzed. Kaplan-Meier analysis revealed that hepatic encephalopathy (HE) met the criteria, while interaction analysis testing was required for other variables. Results from the multivariate Cox regression interaction model showed that ALBI-HE (HR = 1.743, 95% confidence interval [CI] 1.102-2.759, = 0.018), BAR-HE (HR = 0.577, 95% CI 0.367-0.905, = 0.017), and NLA-HE (HR = 0.332, 95% CI 0.195-0.563, < 0.001) were significant independent predictors of 30-day mortality in LC. CTP, MELD, NLR, and de Ritis did not demonstrate statistical significance. ALBI-HE emerged as the strongest predictor based on its HR. Conclusions ALBI-HE, BAR-HE, and NLA-HE have emerged as novel predictors for assessing 30-day mortality in LC. ALBI-HE is the strongest predictor of 30-day mortality in LC.
背景 肝硬化（LC）的特征是肝脏内出现纤维化和结节，导致肝功能进行性减退。多年来，与LC相关的死亡率一直居高不下。诸如Child-Turcotte-Pugh（CTP）评分和终末期肝病模型（MELD）评分等预后工具通常用于预测死亡率和评估LC的严重程度。这两种评分系统均依赖于实验室参数，包括血清白蛋白、总胆红素和国际标准化比值（INR）水平。然而，CTP评分的解读可能存在差异，并且在许多临床环境中并非常规进行INR检测，这可能会限制其效用。本研究旨在评估MELD和CTP评分以及一种新的预测工具在估计LC患者30天死亡率方面的作用。
方法 这项回顾性队列研究聚焦于在恩戈拉中央综合医院被诊断为LC的患者。从病历中收集体格检查数据和实验室比值，包括中性粒细胞与淋巴细胞比值（NLR）、天冬氨酸转氨酶（AST）与丙氨酸转氨酶（ALT）比值（德里斯比值）、中性粒细胞与淋巴细胞与白蛋白比值（NLA）、白蛋白胆红素指数（ALBI）以及血尿素氮与白蛋白比值（BAR）。使用受试者工作特征（ROC）曲线确定最佳截断值。采用Kaplan-Meier方法进行生存分析，并使用多变量Cox回归确定作为30天死亡率预测指标具有统计学意义的每个变量的风险比（HR）。
结果 在本研究中，共分析了140个样本。Kaplan-Meier分析显示肝性脑病（HE）符合标准，而其他变量需要进行交互分析测试。多变量Cox回归交互模型的结果表明，ALBI-HE（HR = 1.743，95%置信区间[CI] 1.102 - 2.759，P = 0.018）、BAR-HE（HR = 0.577，95% CI 0.367 - 0.905，P = 0.017）和NLA-HE（HR = 0.332，95% CI 0.195 - 0.563，P < 0.001）是LC患者30天死亡率的显著独立预测指标。CTP、MELD、NLR和德里斯比值未显示出统计学意义。基于其HR，ALBI-HE成为最强的预测指标。
结论 ALBI-HE、BAR-HE和NLA-HE已成为评估LC患者30天死亡率的新预测指标。ALBI-HE是LC患者30天死亡率的最强预测指标。
