Author/Authors :
Guan ، Yunxuan Department of Infectious Diseases - Changzhou Medical Center, Changzhou Third People s Hospital - Nanjing Medical University , Liu ، Kai Department of Infectious Diseases - Changzhou Medical Center, Changzhou Third People s Hospital - Nanjing Medical University , Zhang ، Xiujun Department of Infectious Diseases - Changzhou Medical Center, Changzhou Third People s Hospital - Nanjing Medical University , Qi ، Caoyan Department of Infectious Diseases - Changzhou Medical Center, Changzhou Third People s Hospital - Nanjing Medical University , Chen ، Xiaolu Department of Infectious Diseases - Changzhou Medical Center, Changzhou Third People s Hospital - Nanjing Medical University , Zhang ، Wenhui Department of Infectious Diseases - Changzhou Medical Center, Changzhou Third People s Hospital - Nanjing Medical University , Chen ، Yan Department of Infectious Diseases - Changzhou Medical Center, Changzhou Third People s Hospital - Nanjing Medical University , Ma ، Yu Department of Infectious Diseases - Changzhou Medical Center, Changzhou Third People s Hospital - Nanjing Medical University , Pu ، Lina Department of Infectious Diseases - Changzhou Medical Center, Changzhou Third People s Hospital - Nanjing Medical University , Yuan ، Jiahong Department of Infectious Diseases - Changzhou Medical Center, Changzhou Third People s Hospital - Nanjing Medical University , Lu ، Niansen Department of Infectious Diseases - Changzhou Medical Center, Changzhou Third People s Hospital - Nanjing Medical University , Zhang ، Chaochao Department of Infectious Diseases - Changzhou Medical Center, Changzhou Third People s Hospital - Nanjing Medical University , Xue ، Yuan Department of Infectious Diseases - Changzhou Medical Center, Changzhou Third People s Hospital - Nanjing Medical University
Abstract :
Background: Hepatic encephalopathy is a severe neuropsychiatric complication of decompensated cirrhosis associated with high short-term mortality. Objectives: This study aimed to evaluate the predictive value of non-invasive scoring systems and develop a prognostic nomogram to identify the risk of 3-month mortality in patients with hepatic encephalopathy. Methods: Retrospective data from 251 patients with decompensated cirrhosis and hepatic encephalopathy were collected. Clinical data and non-invasive scoring systems were compared between survivors and non-survivors using univariate and multivariate logistic regression analyses. A prognostic model was developed and validated using bootstrap resampling procedures. Results: Among the 251 patients, 40 (15.9%) died within three months. The non-survivor group had a higher incidence of complications and higher non-invasive scores (all P 0.01). Multivariate analysis revealed that hepatorenal syndrome, spontaneous bacterial peritonitis, upper gastrointestinal bleeding, and Fibrosis-4 index were independent risk factors. A new model incorporating the Fibrosis-4 index and complications was developed, and discrimination was assessed using a bootstrap-corrected C statistic of 0.831. The area under the receiver operating characteristic curve of the new model (0.840, 95% confidence interval: 0.789 - 0.883) was significantly higher than that of the non-invasive scoring systems (all P 0.05). The calibration plot and Hosmer-Lemeshow test (P = 0.771) showed good calibration accuracy. Kaplan-Meier survival analysis showed that the cumulative survival rate in the high-risk group was significantly lower (P 0.01). Conclusions: The prognostic nomogram consisting of the Fibrosis-4 index and complications can effectively predict the risk of 3-month mortality in patients with hepatic encephalopathy.
Keywords :
Hepatic Encephalopathy , End Stage Liver Disease , Complications , Nomograms , Survival Analysis
