A New Scoring System for Predicting In-hospital Death in Patients Having Liver Cirrhosis With Esophageal Varices
Introduction: Liver cirrhosis is caused by the development of various acute and chronic liver diseases. Esophageal varices is a common and serious complication of liver cirrhosis during decompensation. Despite the development of various treatments, the prognosis for liver cirrhosis with esophageal v...
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Frontiers Media S.A.
2021-10-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.678646/full |
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| author | Fengshuo Xu Fengshuo Xu Luming Zhang Zichen Wang Didi Han Didi Han Chengzhuo Li Chengzhuo Li Shuai Zheng Shuai Zheng Haiyan Yin Jun Lyu Jun Lyu |
| author_facet | Fengshuo Xu Fengshuo Xu Luming Zhang Zichen Wang Didi Han Didi Han Chengzhuo Li Chengzhuo Li Shuai Zheng Shuai Zheng Haiyan Yin Jun Lyu Jun Lyu |
| author_sort | Fengshuo Xu |
| collection | DOAJ |
| description | Introduction: Liver cirrhosis is caused by the development of various acute and chronic liver diseases. Esophageal varices is a common and serious complication of liver cirrhosis during decompensation. Despite the development of various treatments, the prognosis for liver cirrhosis with esophageal varices (LCEV) remains poor. We aimed to establish and validate a nomogram for predicting in-hospital death in LCEV patients.Methods: Data on LCEV patients were extracted from the Medical Information Mart for Intensive Care III and IV (MIMIC-III and MIMIC-IV) database. The patients from MIMIC-III were randomly divided into training and validation cohorts. Training cohort was used for establishing the model, validation and MIMIC-IV cohorts were used for validation. The independent prognostic factors for LCEV patients were determined using the least absolute shrinkage and selection operator (LASSO) method and forward stepwise logistic regression. We then constructed a nomogram to predict the in-hospital death of LCEV patients. Multiple indicators were used to validate the nomogram, including the area under the receiver operating characteristic curve (AUC), calibration curve, Hosmer-Lemeshow test, integrated discrimination improvement (IDI), net reclassification index (NRI), and decision curve analysis (DCA).Results: Nine independent prognostic factors were identified by using LASSO and stepwise regressions: age, Elixhauser score, anion gap, sodium, albumin, bilirubin, international normalized ratio, vasopressor use, and bleeding. The nomogram was then constructed and validated. The AUC value of the nomogram was 0.867 (95% CI = 0.832–0.904) in the training cohort, 0.846 (95% CI = 0.790–0.896) in the validation cohort and 0.840 (95% CI = 0.807–0.872) in the MIMIC-IV cohort. High AUC values indicated the good discriminative ability of the nomogram, while the calibration curves and the Hosmer-Lemeshow test results demonstrated that the nomogram was well-calibrated. Improvements in NRI and IDI values suggested that our nomogram was superior to MELD-Na, CAGIB, and OASIS scoring system. DCA curves indicated that the nomogram had good value in clinical applications.Conclusion: We have established the first prognostic nomogram for predicting the in-hospital death of LCEV patients. The nomogram is easy to use, performs well, and can be used to guide clinical practice, but further external prospective validation is still required. |
| first_indexed | 2024-12-17T12:39:51Z |
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| id | doaj.art-1f102a7deca34c25aeebcc49b206bb84 |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-17T12:39:51Z |
| publishDate | 2021-10-01 |
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| spelling | doaj.art-1f102a7deca34c25aeebcc49b206bb842022-12-21T21:48:04ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-10-01810.3389/fmed.2021.678646678646A New Scoring System for Predicting In-hospital Death in Patients Having Liver Cirrhosis With Esophageal VaricesFengshuo Xu0Fengshuo Xu1Luming Zhang2Zichen Wang3Didi Han4Didi Han5Chengzhuo Li6Chengzhuo Li7Shuai Zheng8Shuai Zheng9Haiyan Yin10Jun Lyu11Jun Lyu12Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, ChinaSchool of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, ChinaIntensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, ChinaDepartment of Public Health, University of California, Irvine, Irvine, CA, United StatesDepartment of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, ChinaSchool of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, ChinaDepartment of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, ChinaSchool of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, ChinaDepartment of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, ChinaSchool of Public Health, Shaanxi University of Chinese Medicine, Xianyang, ChinaIntensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, ChinaDepartment of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, ChinaSchool of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, ChinaIntroduction: Liver cirrhosis is caused by the development of various acute and chronic liver diseases. Esophageal varices is a common and serious complication of liver cirrhosis during decompensation. Despite the development of various treatments, the prognosis for liver cirrhosis with esophageal varices (LCEV) remains poor. We aimed to establish and validate a nomogram for predicting in-hospital death in LCEV patients.Methods: Data on LCEV patients were extracted from the Medical Information Mart for Intensive Care III and IV (MIMIC-III and MIMIC-IV) database. The patients from MIMIC-III were randomly divided into training and validation cohorts. Training cohort was used for establishing the model, validation and MIMIC-IV cohorts were used for validation. The independent prognostic factors for LCEV patients were determined using the least absolute shrinkage and selection operator (LASSO) method and forward stepwise logistic regression. We then constructed a nomogram to predict the in-hospital death of LCEV patients. Multiple indicators were used to validate the nomogram, including the area under the receiver operating characteristic curve (AUC), calibration curve, Hosmer-Lemeshow test, integrated discrimination improvement (IDI), net reclassification index (NRI), and decision curve analysis (DCA).Results: Nine independent prognostic factors were identified by using LASSO and stepwise regressions: age, Elixhauser score, anion gap, sodium, albumin, bilirubin, international normalized ratio, vasopressor use, and bleeding. The nomogram was then constructed and validated. The AUC value of the nomogram was 0.867 (95% CI = 0.832–0.904) in the training cohort, 0.846 (95% CI = 0.790–0.896) in the validation cohort and 0.840 (95% CI = 0.807–0.872) in the MIMIC-IV cohort. High AUC values indicated the good discriminative ability of the nomogram, while the calibration curves and the Hosmer-Lemeshow test results demonstrated that the nomogram was well-calibrated. Improvements in NRI and IDI values suggested that our nomogram was superior to MELD-Na, CAGIB, and OASIS scoring system. DCA curves indicated that the nomogram had good value in clinical applications.Conclusion: We have established the first prognostic nomogram for predicting the in-hospital death of LCEV patients. The nomogram is easy to use, performs well, and can be used to guide clinical practice, but further external prospective validation is still required.https://www.frontiersin.org/articles/10.3389/fmed.2021.678646/fullliver cirrhotic with esophageal varicesMIMICnomogramprognosisin-hospital death |
| spellingShingle | Fengshuo Xu Fengshuo Xu Luming Zhang Zichen Wang Didi Han Didi Han Chengzhuo Li Chengzhuo Li Shuai Zheng Shuai Zheng Haiyan Yin Jun Lyu Jun Lyu A New Scoring System for Predicting In-hospital Death in Patients Having Liver Cirrhosis With Esophageal Varices Frontiers in Medicine liver cirrhotic with esophageal varices MIMIC nomogram prognosis in-hospital death |
| title | A New Scoring System for Predicting In-hospital Death in Patients Having Liver Cirrhosis With Esophageal Varices |
| title_full | A New Scoring System for Predicting In-hospital Death in Patients Having Liver Cirrhosis With Esophageal Varices |
| title_fullStr | A New Scoring System for Predicting In-hospital Death in Patients Having Liver Cirrhosis With Esophageal Varices |
| title_full_unstemmed | A New Scoring System for Predicting In-hospital Death in Patients Having Liver Cirrhosis With Esophageal Varices |
| title_short | A New Scoring System for Predicting In-hospital Death in Patients Having Liver Cirrhosis With Esophageal Varices |
| title_sort | new scoring system for predicting in hospital death in patients having liver cirrhosis with esophageal varices |
| topic | liver cirrhotic with esophageal varices MIMIC nomogram prognosis in-hospital death |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.678646/full |
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