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Derivation and Validation of a Prognostic Model for Acute Decompensated Cirrhosis Patients
Yue Zhang1, Peng Chen1, Wang Zhang1
1Department of Gastroenterology, Jiangxi Province and Jiangxi Clinical Research Center for Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
Insights
A new score model effectively predicts long-term mortality in patients with acute decompensated cirrhosis (AD). This model demonstrates superior prognostic value compared to existing scores like CTP and MELD.
Area of Science:
- Hepatology
- Internal Medicine
- Medical Statistics
Background:
- Acute decompensated cirrhosis (AD) presents significant challenges due to high mortality and medical costs.
- Existing scoring models for AD prognosis include Child-Turcotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD), and CLIF-C AD score.
Purpose of the Study:
- To develop and validate a novel score model for predicting long-term mortality in patients with AD.
- To compare the performance of the new score model against established prognostic tools.
Main Methods:
- A cohort of 703 AD patients was divided into training (n=528) and validation (n=175) sets.
- Cox regression analysis identified risk factors for prognosis, forming the basis of the new score model.
- Prognostic value was assessed using the area under the receiver operating characteristic curve (AUROC).
Main Results:
- The new score model incorporates age, bilirubin, INR, WBC, albumin, ALT, and BUN.
- In the training cohort, 36.3% of patients died within 6 months; in the validation cohort, 29.1% died.
- The developed prognostic score demonstrated superior predictive accuracy over CTP, MELD, and CLIF-C AD scores in both training and validation.
Conclusions:
- The novel score model is a validated tool for assessing long-term survival in AD patients.
- This new model offers improved prognostic value compared to CTP, MELD, and CLIF-C AD scores.
Background:
Acute decompensated cirrhosis (AD) is related to high medical costs and high mortality. We recently proposed a new score model to predict the outcome of AD patients and compared it with the common score model (CTP, MELD and CLIF-C AD score) in the training and validation sets.
Materials And Methods:
A total of 703 patients with AD were enrolled from The First Affiliated Hospital of Nanchang University between December 2018 and May 2021. These patients were randomly assigned to the training set (n=528) and validation set (n=175). Risk factors affecting prognosis were identified by Cox regression analysis and then used to establish a new score model. The prognostic value was determined by the area under the receiver operating characteristic curve (AUROC).
Results:
A total of 192 (36.3%) patients in the training cohort and 51 (29.1%) patients in the validation cohort died over the course of 6 months. A new score model was developed with predictors including age, bilirubin, INR, WBC, albumin, ALT and BUN. The new prognostic score (0.022×Age + 0.003×TBil + 0.397×INR + 0.023×WBC- 0.07×albumin + 0.001×ALT + 0.038×BUN) for long-term mortality was superior to three other scores based on both training and internal validation studies.
Conclusion:
This new score model appears to be a valid tool for assessing the long-term survival of AD patients, improving the prognostic value compared with the CTP, MELD and CLIF-C AD scores.
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