A novel laboratory-based nomogram for assessing infection presence risk in acute-on-chronic liver failure patients
Abstract Accurate assessment of infection presence risk level, timely diagnosis, and effective control are critical for decreasing mortality of Acute‑on‑chronic liver failure (ACLF). We aimed to develop and validate a novel diagnostic model to accurately assess infection presence risk level in ACLF...
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| Format: | Article |
| Language: | English |
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Nature Portfolio
2023-10-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-023-44006-9 |
| _version_ | 1797452929472397312 |
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| author | Rui Sun Wenli Lu Wanhua Ren Shuhong Zhang Dongxue Yao Nannan Zhang Keqing Zhong Wenrui Zhao Xiaolin Tang Meihong Han Tao Li |
| author_facet | Rui Sun Wenli Lu Wanhua Ren Shuhong Zhang Dongxue Yao Nannan Zhang Keqing Zhong Wenrui Zhao Xiaolin Tang Meihong Han Tao Li |
| author_sort | Rui Sun |
| collection | DOAJ |
| description | Abstract Accurate assessment of infection presence risk level, timely diagnosis, and effective control are critical for decreasing mortality of Acute‑on‑chronic liver failure (ACLF). We aimed to develop and validate a novel diagnostic model to accurately assess infection presence risk level in ACLF patients. 185 ACLF patients with/without infection were enrolled, and their demographic, physical findings, immune-inflammatory, hepatic function, metabolism, and coagulation-fibrinolysis indicators were analyzed. Regression analysis was performed to identify the independent diagnostic parameters, which were further used to establish diagnostic models with a nomogram for visual. An area under receiver operating characteristic curve (AUROC), calibration plots, clinical impact curves, decision curve analysis, and net reclassification index were used to evaluate and identify the best model. An external validating cohort was introduced to verify the diagnostic accuracy. We screened out white blood cell (WBC) count, LYM%, blood urea nitrogen (BUN), and D-dimer for assessing infection presence risk levels in ACLF patients. WBD (WBC + BUN + D-dimer) was established and proposed as a novel diagnostic model for infection presence risk levels assessment in ACLF patients with an AUROC of 0.803 (95%CI 0.723–0.883), 0.885 (95%CI 0.786–0.984) in training and external cohorts, respectively. In stratification analysis by ACLF etiology and stages, WBD achieved an AUROC of 0.791 (95%CI 0.691–0.891) and 0.873 (95%CI 0.78–0.966) in HBV-related and early-stage patients, respectively. Whereas a higher AUROC of 0.905 (95%CI 0.807–1.00) in the early-stage of HBV-related ACLF patients indicated its optimum application scope. WBD, a novel laboratory-based nomogram, can serve as a decision-making support tool for clinicians to assess infection presence risk levels in ACLF patients. |
| first_indexed | 2024-03-09T15:15:47Z |
| format | Article |
| id | doaj.art-9f3362c08f2a497fb0e8a63efd0edd18 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-03-09T15:15:47Z |
| publishDate | 2023-10-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-9f3362c08f2a497fb0e8a63efd0edd182023-11-26T13:07:50ZengNature PortfolioScientific Reports2045-23222023-10-0113111210.1038/s41598-023-44006-9A novel laboratory-based nomogram for assessing infection presence risk in acute-on-chronic liver failure patientsRui Sun0Wenli Lu1Wanhua Ren2Shuhong Zhang3Dongxue Yao4Nannan Zhang5Keqing Zhong6Wenrui Zhao7Xiaolin Tang8Meihong Han9Tao Li10Department of Infectious Diseases, Shandong Provincial Hospital, Shandong UniversityDepartment of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityDepartment of Infectious Diseases, Shandong Provincial Hospital, Shandong UniversityDepartment of Infectious Diseases, Jinan Central Hospital Affiliated to Shandong First Medical UniversityDepartment of Infectious Diseases, Jinan Central Hospital Affiliated to Shandong First Medical UniversityDepartment of Infectious Diseases, Shandong Provincial Hospital, Shandong UniversityDepartment of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityDepartment of Infectious Diseases, Shandong Provincial Hospital, Shandong UniversityDepartment of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityDepartment of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityDepartment of Infectious Diseases, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityAbstract Accurate assessment of infection presence risk level, timely diagnosis, and effective control are critical for decreasing mortality of Acute‑on‑chronic liver failure (ACLF). We aimed to develop and validate a novel diagnostic model to accurately assess infection presence risk level in ACLF patients. 185 ACLF patients with/without infection were enrolled, and their demographic, physical findings, immune-inflammatory, hepatic function, metabolism, and coagulation-fibrinolysis indicators were analyzed. Regression analysis was performed to identify the independent diagnostic parameters, which were further used to establish diagnostic models with a nomogram for visual. An area under receiver operating characteristic curve (AUROC), calibration plots, clinical impact curves, decision curve analysis, and net reclassification index were used to evaluate and identify the best model. An external validating cohort was introduced to verify the diagnostic accuracy. We screened out white blood cell (WBC) count, LYM%, blood urea nitrogen (BUN), and D-dimer for assessing infection presence risk levels in ACLF patients. WBD (WBC + BUN + D-dimer) was established and proposed as a novel diagnostic model for infection presence risk levels assessment in ACLF patients with an AUROC of 0.803 (95%CI 0.723–0.883), 0.885 (95%CI 0.786–0.984) in training and external cohorts, respectively. In stratification analysis by ACLF etiology and stages, WBD achieved an AUROC of 0.791 (95%CI 0.691–0.891) and 0.873 (95%CI 0.78–0.966) in HBV-related and early-stage patients, respectively. Whereas a higher AUROC of 0.905 (95%CI 0.807–1.00) in the early-stage of HBV-related ACLF patients indicated its optimum application scope. WBD, a novel laboratory-based nomogram, can serve as a decision-making support tool for clinicians to assess infection presence risk levels in ACLF patients.https://doi.org/10.1038/s41598-023-44006-9 |
| spellingShingle | Rui Sun Wenli Lu Wanhua Ren Shuhong Zhang Dongxue Yao Nannan Zhang Keqing Zhong Wenrui Zhao Xiaolin Tang Meihong Han Tao Li A novel laboratory-based nomogram for assessing infection presence risk in acute-on-chronic liver failure patients Scientific Reports |
| title | A novel laboratory-based nomogram for assessing infection presence risk in acute-on-chronic liver failure patients |
| title_full | A novel laboratory-based nomogram for assessing infection presence risk in acute-on-chronic liver failure patients |
| title_fullStr | A novel laboratory-based nomogram for assessing infection presence risk in acute-on-chronic liver failure patients |
| title_full_unstemmed | A novel laboratory-based nomogram for assessing infection presence risk in acute-on-chronic liver failure patients |
| title_short | A novel laboratory-based nomogram for assessing infection presence risk in acute-on-chronic liver failure patients |
| title_sort | novel laboratory based nomogram for assessing infection presence risk in acute on chronic liver failure patients |
| url | https://doi.org/10.1038/s41598-023-44006-9 |
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