Novel nomogram model for predicting 6‐week mortality in liver cirrhosis patients with acute upper gastrointestinal bleeding

Zhou, Yufen; Xu, Ying; Ding, Yanfei; Yu, Xiaokang; Wu, Ying; Chen, Ping; Zou, Duowu

doi:10.1111/1751-2980.13137

Cited by 5 publications

(2 citation statements)

References 34 publications

(67 reference statements)

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“…According to predictive models for prognosis, systemic reviews of clinical data revealed that six independent risk factors (TB, INR, age, neutrophil count, HE level and urea level) appeared to be promising candidates for predicting poor prognosis, and multiple simpli ed prognostic scores were further developed for patients with HBV-ACLF [22][23][24]. In addition, upper gastrointestinal hemorrhage was also identi ed as an independent prognostic predictor for 6-week mortality in patients with liver cirrhosis [29]. However, there are no effective models for predicting disease prognosis in HBV-ACLF patients receiving arti cial liver therapy.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a novel prognostic nomogram for hepatitis B virus-related acute-on-chronic liver failure patients receiving artificial liver therapy

Wang,

Yang,

et al. 2024

Preprint

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Background Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) is frequently accompanied by short-term morbidity and mortality. However, there have been no studies on the associations between baseline clinicopathologic characteristics at hospital admission and clinical prognosis after receiving artificial liver therapy. Therefore, the current study aimed to develop a prognostic nomogram for predicting the outcomes of patients with HBV-ACLF following artificial liver support. Methods A retrospective study of 110 consecutive patients who were diagnosed with HBV-ACLF between January 2018 and August 2022 was conducted. First, univariate and multivariate logistic regression analyses were performed to determine the independent prognostic factors significantly associated with patient outcomes. Moreover, a predictive nomogram model underlying the prognostic factors was established and further evaluated. The area under the curve (AUC) was used to gauge the predictive accuracy. The calibration curve and decision curve analysis (DCA) were employed to assess the discriminability and clinical effectiveness, respectively. Results In patients with HBV-ACLF, multivariate logistic analysis revealed that age ≥ 40 years (OR 6.76, p = 0.025), middle-stage liver failure (OR 49.96, p < 0.001), end-stage liver failure (OR 19.27, p = 0.002), hepatic encephalopathy (OR 7.06, p = 0.032), upper gastrointestinal hemorrhage (OR 47.24, p = 0.047), and artificial liver therapy consisting of plasma exchange (PE) + plasma exchange double plasma molecular adsorption system (DPMAS) (OR 0.26, p = 0.04) were identified as prognostic factors. Then, we established and evaluated a predictive nomogram with an area under the curve (AUC) of 0.885, which showed better predictive accuracy than the model for end-stage liver disease (MELD) score (AUC of 0.634) and the Child‒Pugh score (AUC of 0.611). Moreover, the calibration curve showed good agreement between the ideal and bias-corrected curves. Decision curve analysis confirmed the better clinical utility of this approach. Conclusion We developed and evaluated a unique nomogram that was more accurate than conventional prognostic models for predicting the clinical prognosis of HBV-ACLF patients receiving artificial liver therapy. As a result, the nomogram may be a helpful tool in clinical decision-making to predict the outcomes of patients with HBV-ACLF.

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Section: Discussionmentioning

confidence: 99%

Development and validation of a novel prognostic nomogram for hepatitis B virus-related acute-on-chronic liver failure patients receiving artificial liver therapy

Wang,

Yang,

et al. 2024

Preprint

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“…In the case of UGIB in patients with liver cirrhosis, acute peripheral circulatory failure may suddenly occur, resulting in decreased blood perfusion in liver tissues, often accompanied by clinical manifestations such as blood volume decline, melena, and haematemesis. This disease progresses rapidly, with a mortality rate of Effects of gastrointestinal endoscopy at different time points on diagnosis and treatment of upper gastrointestinal bleeding in patients with liver cirrhosis above 10% if not treated promptly [4]. It is mentioned in Expert Consensus on Emergency Diagnosis and Treatment Procedures for Acute Upper Gastrointestinal Bleeding that gastrointestinal endoscopy is an effective means of diagnosis and treatment of UGIB upon liver cirrhosis [5].…”

Section: Introductionmentioning

confidence: 99%

Effects of gastrointestinal endoscopy at different time points on diagnosis and treatment of upper gastrointestinal bleeding in patients with liver cirrhosis.

Sun,

Zhou,

Shu

et al. 2023

Videosurgery and Other Miniinvasive Techniques

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Introduction Liver cirrhosis is a common diffuse and persistent liver disease in the gastroenterology department. Aim To assess the effects of gastrointestinal endoscopy at different time points on the diagnosis and treatment of upper gastrointestinal bleeding (UGIB) in patients with liver cirrhosis. Material and methods The clinical data of 102 liver cirrhosis patients with UGIB admitted from July 2020 to May 2022 were retrospectively analysed. According to the timing of the first gastroscopy after hospitalization, the patients were divided into 4 groups: Group A (n = 25, gastroscopy performed within 12 h of the first bleeding), Group B (n = 29, gastroscopy performed within 12–48 h of the first bleeding), Group C (n = 25, elective gastroscopy performed > 48 h after the first bleeding), and Group D (n = 23, emergency gastroscopy was conducted due to active bleeding manifestations after failure of medication). Results The success rate of haemostasis in Group A was higher than in Groups B–D (p < 0.05). The early rebleeding rates of the 4 groups were similar (p > 0.05). After treatment, the levels of serum malondialdehyde and lipid hydrogen peroxide declined but the levels of glutathione peroxidase and superoxide dismutase rose in all groups compared to those immediately after hospitalization (p < 0.05), and these indicators were improved more significantly in Group A (p < 0.05). Conclusions Gastroscopy performed within 12 h of the first bleeding is more conducive to improving the haemostatic effect and thus shortening the length of hospital stay.

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Establishment and validation of a nomogram model for riskprediction of hepatic encephalopathy: a retrospective analysis

Yao,

Huang,

Wang

et al. 2023

Sci Rep

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To establish a high-quality, easy-to-use, and effective risk prediction model for hepatic encephalopathy, to help healthcare professionals with identifying people who are at high risk of getting hepatic encephalopathy, and to guide them to take early interventions to reduce the occurrence of hepatic encephalopathy. Patients (n = 1178) with decompensated cirrhosis who attended the First Affiliated Hospital of Guangxi University of Chinese Medicine between January 2016 and June 2022 were selected for the establishment and validation of a nomogram model for risk prediction of hepatic encephalopathy. In this study, we screened the risk factors for the development of hepatic encephalopathy in patients with decompensated cirrhosis by univariate analysis, LASSO regression and multifactor analysis, then established a nomogram model for predicting the risk of getting hepatic encephalopathy for patients with decompensated cirrhosis, and finally performed differentiation analysis, calibration analysis, clinical decision curve analysis and validation of the established model. A total of 1178 patients with decompensated cirrhosis who were hospitalized and treated at the First Affiliated Hospital of Guangxi University of Chinese Medicine between January 2016 and June 2022 were included for modeling and validation. Based on the results of univariate analysis, LASSO regression analysis and multifactor analysis, a final nomogram model with age, diabetes, ascites, spontaneous peritonitis, alanine transaminase, and blood potassium as predictors of hepatic encephalopathy risk prediction was created. The results of model differentiation analysis showed that the AUC of the model of the training set was 0.738 (95% CI 0.63–0.746), while the AUC of the model of the validation set was 0.667 (95% CI 0.541–0.706), and the two AUCs indicated a good discrimination of this nomogram model. According to the Cut-Off value determined by the Jorden index, when the Cut-Off value of the training set was set at 0.150, the sensitivity of the model was 72.8%, the specificity was 64.8%, the positive predictive value was 30.4%, and the negative predictive value was 91.9%; when the Cut-Off value of the validation set was set at 0.141, the sensitivity of the model was 69.7%, the specificity was 57.3%, the positive predictive value was 34.5%, and the negative predictive value was 84.7%. The calibration curve and the actual events curve largely overlap at the diagonal, indicating that the prediction with this model has less error. The Hosmer–Lemeshow test for goodness of fit was also applied, and the results showed that for the training set, χ2 = 1.237587, P = 0.998, and for the validation set, χ2 = 31.90904, P = 0.0202, indicating that there was no significant difference between the predicted and actual observed values. The results of the clinical decision curve analysis showed that the model had a good clinical benefit, compared with the two extreme clinical scenarios (all patients treated or none treated), and the model also had a good clinical benefit in the validation set. This study showed that aged over 55 years, complications of diabetes, ascites, and spontaneous bacterial peritonitis, abnormal glutamate aminotransferase and abnormal blood potassium are independent risks indicators for the development of hepatic encephalopathy in patients with decompensated cirrhosis. The nomogram model based on the indicators mentioned above can effectively and conveniently predict the risk of developing hepatic encephalopathy in patients with decompensated cirrhosis. The nomogram model established on this study can help clinical healthcare professionals to timely and early identify patients with high risk of developing hepatic encephalopathy.

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Novel nomogram model for predicting 6‐week mortality in liver cirrhosis patients with acute upper gastrointestinal bleeding

Cited by 5 publications

References 34 publications

Development and validation of a novel prognostic nomogram for hepatitis B virus-related acute-on-chronic liver failure patients receiving artificial liver therapy

Development and validation of a novel prognostic nomogram for hepatitis B virus-related acute-on-chronic liver failure patients receiving artificial liver therapy

Effects of gastrointestinal endoscopy at different time points on diagnosis and treatment of upper gastrointestinal bleeding in patients with liver cirrhosis.

Establishment and validation of a nomogram model for riskprediction of hepatic encephalopathy: a retrospective analysis

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