Serum Urea Predicts Long-term Mortality in Hospitalized Patients with Decompensated Cirrhosis

Objectives: The purpose of the present study was to investigate the prognostic value of serum urea for 90 days and six months’ mortality in hospitalized patients with Decompensated Cirrhosis (DeCi). Methods: We performed a single-center, observational prospective study with data from 456 enrolled patients with DeCi. The biochemical examination and patient demographics were obtained upon admission after 24 h. All patients were observed until death, loss to follow-up, or for six months. Univariate and multivariate analyses were used to determine whether serum urea was independently associated with the prognosis of DeCi patients. The AUROC was implemented to test the predictive accuracy compared to existing scores. Results: Serum urea was significantly higher in non-surviving patients than in surviving patients. Multivariate analysis demonstrated that the urea level was an independent predictor of 90 days’ (odds ratio: 1.084, P = 0.001) and six months’ (odds ratio: 1.070, P = 0.009) mortality. The ROC curves were established to evaluate the relative efficiencies of the urea level for predicting 90 days’ (AUROC: 0.728, P 0.0001) and six months’ (AUROC: 0.715, P 0.0001) mortality. The performance of the new scores, in which lg urea was added to the MELD score and the Child-Pugh score, was better than the MELD score and Child-Pugh score alone, respectively (P 0.001). Conclusions: Serum urea levels at admission may be useful for predicting long-term mortality in DeCi patients and the predictive value of MELD score and Child-Pugh score improved by adding lg urea.