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Development and validation of a nomogram for predicting 28-day mortality in critically ill liver cirrhotic patients
Yongxu Lin1,2, Liqin Wei3, Xujin Wei1,2
1Endoscopy Center, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
Background:
Although scoring systems exist to predict outcomes in patients with cirrhosis, specific systems for critically ill cirrhotic patients with coagulopathy are lacking. The aim of the study was to establish a reliable predictive model for 28-day mortality in cirrhotic patients with coagulopathy admitted to the intensive care unit.
Methods:
The 880 cirrhotic patients with coagulopathy admitted to the intensive care unit from 2008 to 2022 in the Medical Information Mart for Intensive Care-IV database were randomly allocated to training (n = 616) and validation (n = 264) cohorts. Independent predictors of 28-day mortality were identified by logistic regression analysis and used to construct a nomogram.
Results:
Age, white blood cell count, activated partial thromboplastin time, prothrombin time, total bilirubin level, blood lactate level, and blood bicarbonate level were identified as independent predictors of 28-day mortality. The nomogram showed good discrimination in the training (concordance index, 0.885; 95% confidence interval, 0.855-0.915) and validation (concordance index, 0.909; 95% confidence interval, 0.871-0.948) cohorts. Calibration, receiver operating characteristic, and clinical decision curves showed that the nomogram had good predictive ability.
Conclusions:
The nomogram exhibited superior discernment and accuracy to SOFA, MELD3.0, ABIC scores and may help identify high-risk patients to allow early intervention and potentially improve clinical outcomes.