Baseline characteristics
A total of 405 patients hospitalized with DeCi from January 2014 to December 2018 in this retrospective study. Patient age ranged from 25 to 86 years (median: 53.5 years). The majority of the patients were male (302/456, 74.6%). Demographic and biochemical characteristics of the study population are outlined in Table 1. The predominant etiology of liver cirrhosis was hepatitis, in 62.0% of patients (251/405), followed by alcoholic (14.8%) and cryptogenic cirrhosis (8.4%). The most common decompensation events responsible for hospitalization were gastrointestinal hemorrhage (61.2%), infection (23.2%), hepatic encephalopathy (8.1%), and ascites (7.4%). The average length of hospital stay was 10 (8-12) days. Sixty-eight patients (16.7%) received treatment in the intensive care unit (ICU), and 337 (83.2%) patients received treatment in the general ward. A total of 298 patients had been followed up to 6 months, including 84 patients who died. The causes of death were as follows: 15 (17.9%) from respiratory failure, 39 (46.4%) patients from hemorrhagic shock, 9 (10.7%) patients from hepatic encephalopathy, 8 (9.5%) patients from infectious shock, 5 (5.9%) patients from hepatorenal syndrome, 4 (4.8%) patients from liver failure, and 4 (4.8%) patients from uncertain causes. The baseline characteristics of this cohort are presented in Table 1.
Association between mortality and clinical or laboratory characteristics.
The clinical and laboratory characteristics of these patients are listed in Table 2. DeCi patients were divided into nonsurviving (n=84) and surviving groups (n=214) according to 6-month survival outcomes. The majority of nonsurvivors had been graded higher, as reflected by ALT, AST, bilirubin, GGT, creatinine, INR, PTA, WBC, Lac, Child-Pugh score, and MELD score. However, albumin levels were lower in nonsurvivors. No significant differences in platelet, serum Na, MAP, or PO2/FiO2 were detected.
Univariate and multivariate analysis for 6-months mortality in DeCi patients
When index hospitalization variables were compared, univariate logistic regression analysis showed that >50 years of age, cryptogenic cirrhosis, 3rd-degree ascites, Hepatocellular carcinoma (HCC), ALT, AST, bilirubin, GGT, creatinine, INR, PTA, WBC, Lactate, Child-Pugh score, and MELD score were risk factors and albumin was a protection factor for 6-months mortality in patients with DeCi. Multivariate logistic regression analysis identified that >50 years of age, HCC, GGT, creatinine, and Lactate were risk factors and albumin was a protective factor for 6-months mortality in patients with DeCi. No significant effect was noted for sex, cause of hospitalization, ACLF, acute renal injury, platelets, serum Na, mean arterial pressure, or PaO2/FiO2.
Predictive value for 6-months mortality in DeCi patients
Figure 1 shows the performance analysis of the discriminative accuracy of Lac for 6-months mortality with AUROC of 0.716 (95% CI: 0.649-0.784, P<0.001). The AUROC of MELD score and Child-Pugh score were 0.723 (95% CI: 0.654-0.791, P<0.001) and 0.679 (95% CI: 0.613-0.744, P<0.001), respectively. The ROC curves and comparison of prognostic scores are shown in Figure 1 and Table 4, respectively.
Predictive value of MELD score and Child-Pugh score are improved by adjusting lactate
To improve the predictive value, new scores (MELD+ lactate score, Child-Pugh+ lactate score), created by adding lactate to the MELD score and Child-Pugh score, were established. In the same dataset, an analysis of AUROC at 6-months mortality showed that MELD+ lactate score and Child-Pugh+ lactate score were superior to MELD score and Child-Pugh score, respectively (difference between areas=0.045, 95% CI= 0.017-0.073, Z=3.191, P=0.001; difference between areas=0.087, 95% CI= 0.043-0.131, Z=3.874, P<0.001). The ROC curve and comparison of prognostic scores are shown in Figure 2 and Table 5, respectively.