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D-dimer is a prognostic marker for 1-year mortality in patients with chronic liver failure and hepatic encephalopathy
Yi-Shan He1, Su-Hua Yang1, Ze-Yu Huang2
1College of Changzhou Clinical, Nanjing Medical University, Changzhou, China.
Insights
D-dimer levels predict 1-year mortality in patients with chronic liver failure and hepatic encephalopathy (HE). Higher D-dimer indicates poorer prognosis, suggesting its value as a prognostic marker in HE management.
Area of Science:
- Hepatology
- Clinical Medicine
- Biomarker Research
Background:
- Hepatic encephalopathy (HE) is a severe complication of liver failure with significant mortality.
- Current prognostic markers for HE may not fully capture patient outcomes.
- The predictive value of D-dimer in HE requires further investigation.
Purpose of the Study:
- To evaluate the predictive capability of D-dimer for 1-year mortality in patients with chronic liver failure (CLF) and HE.
- To identify independent risk factors for mortality in HE patients.
- To develop and assess a novel prognostic model for HE mortality.
Main Methods:
- Retrospective analysis of patients with CLF and HE.
- Univariate and multivariate logistic regression to identify mortality risk factors.
- Correlation analysis between D-dimer, INR, MELD, Child-Pugh scores, and HE grades.
- Development and validation of a predictive model (Model(Age_DD_ALT_Na)) using key risk factors.
Main Results:
- 39.2% of HE patients died within the first year.
- D-dimer levels were significantly higher in non-survivors (p<0.01).
- Age, D-dimer, ALT, and sodium were identified as independent risk factors for 1-year mortality.
- The developed Model(Age_DD_ALT_Na) showed superior predictive accuracy (AUROC=0.732) compared to MELD and Child-Pugh scores.
Conclusions:
- D-dimer serves as a valuable prognostic marker for 1-year mortality in patients with CLF and HE.
- The novel Model(Age_DD_ALT_Na) offers improved prediction of mortality in HE patients.
- These findings may aid in risk stratification and management strategies for HE.
Background And Aim:
Hepatic encephalopathy (HE) is a neuropsychiatric complication of liver failure with poor outcomes. The present study aimed to evaluate the predictive values of D-dimer in patients with HE.
Materials And Methods:
Patients with chronic liver failure (CLF) and HE were enrolled. Univariate and multivariate logistic analysis was performed to investigate the risk factors for 1-year mortality of HE.
Results:
During the first year after diagnosis, 39.2% (65/166) of the patients died. D-dimer was significantly higher in non-survivors (Z=2.617, p<0.01). Both D-dimer and international normalized ratio (INR) positively correlated with Child-Pugh and MELD scores, and negatively correlated with sodium (all p<0.01). Moreover, there was a negative relationship between D-dimer and HE grades (r=-0.168, p=0.031), while the relationship between INR and HE grades was not significant (r=0.083, p=0.289). Multivariate analysis showed that age (odds ratio (OR):1.035, 95% CI:1.004-1.067, p=0.03), D-dimer (OR=1.138, 95% CI:1.030-1.258, p=0.01), ALT (OR=1.012, 95% CI:1.001-1.022, p=0.03), and sodium (OR=0.920, 95% CI:0.858-0.986, p=0.02) were independent risk factors for 1-year mortality. Then, a new model Model(Age_DD_ALT_Na) incorporating age, D-dimer, ALT, and sodium was developed. AUROC of Model(Age_DD_ALT_Na) was 0.732, which was significantly higher than MELD and Child-Pugh scores (AUROC: 0.602 and 0.599, p=0.013 and 0.022).
Conclusion:
D-dimer is a prognostic marker for 1-year mortality in patients with CLF and HE.
