中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 5
May  2023
Turn off MathJax
Article Contents

Establishment and evaluation of a multivariate Cox proportional-hazards prediction model for mortality during short-term hospitalization in patients with liver cirrhosis and sepsis

DOI: 10.3969/j.issn.1001-5256.2023.05.014
Research funding:

Special Fund for Scientific Research of You'an Professional Alliance (LM202014)

More Information
  • Corresponding author: LIU Li, liuli197210@163.com (ORCID: 0000-0001-7712-4931)
  • Received Date: 2022-12-01
  • Accepted Date: 2023-02-21
  • Published Date: 2023-05-20
  •   Objective  To establish a Cox proportional-hazards prediction model for mortality during short-term hospitalization in patients with liver cirrhosis and sepsis.  Methods  A retrospective analysis was performed for the clinical data of 336 patients with liver cirrhosis and sepsis who were admitted to The Third People's Hospital of Kunming from January 2012 to August 2022, and according to whether the patient died during short-term hospitalization, they were divided into death group with 40 patients and survival group with 296 patients. Demographic data, comorbidities, and clinical biochemical parameters were collected and compared between the two groups. The independent-samples t test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. The multivariate Cox analysis was used for screening of variables, then a Cox proportional-hazards prediction model was established, and hazard ratio (HR) and its 95% confidence interval [CI] were calculated; C-index index was used to evaluate the prediction accuracy of the model. The Cox proportional-hazards prediction model was visualized by a nomogram, and calibration curve was plotted to evaluate the consistency between the prediction results of the model and the actual condition.  Results  Among the 336 patients, there were 261 male patients (77.7%) and 75 female patients (22.3%), with a mean age of 50.0±10.6 years, and 40 patients died, with a mean hospital stay of 16.8±11.3 days (range 8.2-23.0 days). Compared with the survival group, the death group had a significantly higher proportion of patients with an age of ≥60 years, a history of invasive operation within the past two weeks, gastrointestinal bleeding, hepatic encephalopathy (HE) or hepatorenal syndrome (HRS), a significantly higher Modified Early Warning Score (MEWS) score, and significantly higher levels of prothrombin time (PT), activated partial thromboplastin time, international normalized ratio, D-dimer, CD4/CD8 ratio, lactate, white blood cell count, norepinephrine, total bilirubin, interleukin-6, procalcitonin, high-sensitivity C-reactive protein (hsCRP), blood urea nitrogen, and creatinine (all P < 0.05), as well as significantly lower levels of red blood cell count, hemoglobin, albumin, total cholesterol, low-density lipoprotein, and high-density lipoprotein (all P < 0.05). The multivariate Cox regression analysis showed that age (HR=2.602, 95%CI: 1.277-5.303, P=0.008), HE (HR=2.516, 95%CI: 1.258-5.033, P=0.009), HRS (HR=2.324, 95%CI: 1.010-5.349, P=0.047), hsCRP (HR=1.008, 95%CI: 1.003-1.013, P=0.004), MEWS score (HR=1.205, 95%CI: 1.022-1.422, P=0.027), and PT (HR=1.076, 95%CI: 1.030-1.124, P=0.027) were independent influencing factors for death in patients with liver cirrhosis and sepsis. The model showed a C-index of 0.857 (95%CI: 0.815-0.920), suggesting that the model had relatively high prediction accuracy, and the calibration curve showed good consistency between the predicted risk and the actual risk.  Conclusion  The Cox proportional-hazards prediction model established for death during short-term hospitalization in patients with liver cirrhosis and sepsis can be used to predict the risk of death during short-term hospitalization in patients with liver cirrhosis and sepsis, thereby guiding clinical medical staff to take targeted intervention measures to avoid or reduce the possibility of death in patients.

     

  • loading
  • [1]
    DELLINGER RP, LEVY MM, SCHORR CA, et al. 50 years of sepsis investigation/enlightenment among adults-the long and winding road[J]. Crit Care Med, 2021, 49(10): 1606-1625. DOI: 10.1097/CCM.0000000000005203.
    [2]
    HUANG HK, CHEN HY, HSU YC. Comparing the prognosis of patient with alcohol and nonalcohol-associated cirrhosis with bacteremia[J]. Alcohol Alcohol, 2020, 55(5): 512-517. DOI: 10.1093/alcalc/agaa057.
    [3]
    CHEN HY, HSU YC. Afebrile bacteremia in adult emergency department patients with liver cirrhosis: clinical characteristics and outcomes[J]. Sci Rep, 2020, 10(1): 7617. DOI: 10.1038/s41598-020-64644-7.
    [4]
    CHATTERJEE S, KAWAHARA R, TJONDRO HC, et al. Serum N-glycomics stratifies bacteremic patients infected with different pathogens[J]. J Clin Med, 2021, 10(3): 516. DOI: 10.3390/jcm10030516.
    [5]
    JOHNSON AL, RATNASEKERA IU, IRVINE KM, et al. Bacteraemia, sepsis and antibiotic resistance in Australian patients with cirrhosis: a population-based study[J]. BMJ Open Gastroenterol, 2021, 8(1): e000695. DOI: 10.1136/bmjgast-2021-000695.
    [6]
    Chinese Society of Hepatology, Chinese Medical Association, Chinese Society of Infectious Diseases, Chinese Medical Association. Guidelines for the prevention and treatment of hepatitis C(2019 version)[J]. J Clin Hepatol, 2019, 35(12): 2670-2686. DOI: 10.3969/j.issn.1001-5256.2019.12.008.

    中华医学会肝病学分会, 中华医学会感染病学分会. 丙型肝炎防治指南(2019年版)[J]. 临床肝胆病杂志, 2019, 35(12): 2670-2686. DOI: 10.3969/j.issn.1001-5256.2019.12.008.
    [7]
    Chinese Society of Hepatology, Chinese Medical Association, Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B(2010 version)[J]. J Clin Hepatol, 2011, 27(1): 113-128. http://lcgdbzz.org/article/id/LCGD201101035

    中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2010年版)[J]. 临床肝胆病杂志, 2011, 27(1): 113-128. http://lcgdbzz.org/article/id/LCGD201101035
    [8]
    Fatty Liver Expert Committee, Chinese Medical Doctor Association, National Workshop on Fatty Liver and Alcoholic Liver Disease, Chinese Society of Hepatology, Chinese Medical Association. Guidelines of prevention and treatment for alcoholic liver disease: a 2018 update[J]. J Clin Hepatol, 2018, 34(5): 939-946. DOI: 10.3969/j.issn.1001-5256.2018.05.006.

    中国医师协会脂肪性肝病专家委员会, 中华医学会肝病学分会脂肪肝和酒精性肝病学组. 酒精性肝病防治指南(2018年更新版)[J]. 临床肝胆病杂志, 2018, 34(5): 939-946. DOI: 10.3969/j.issn.1001-5256.2018.05.006.
    [9]
    National Workshop on Fatty Liver and AlcoholicLiver Disease, Chinese Society of Hepatology, Chinese Medical Association. Guidelines on the diagnosis and management ofprimary biliary cholangitis (2021)[J]. J Clin Hepatol, 2022, 38(1): 35-41. DOI: 10.3969/j.issn.1001-5256.2022.01.007

    中华医学会肝病学分会. 原发性胆汁性胆管炎的诊断和治疗指南(2021)[J]﹒临床肝胆病杂志, 2022, 38(1): 35-41. DOI: 10.3969/j.issn.1001-5256.2022.01.007
    [10]
    Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Gastroenterology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Consensus on the diagnosis and management of autoimmune hepatitis(2015)[J]. J Clin Hepatol, 2016, 32(1): 9-22. DOI: 10.3969/j.issn.1001-5256.2016.01.002.

    中华医学会肝病学分会, 中华医学会消化病学分会, 中华医学会感染病学分会. 自身免疫性肝炎诊断和治疗共识(2015)[J]. 临床肝胆病杂志, 2016, 32(1): 9-22. DOI: 10.3969/j.issn.1001-5256.2016.01.002.
    [11]
    SINGER M, DEUTSCHMAN CS, SEYMOUR CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)[J]. JAMA, 2016, 315(8): 801-810. DOI: 10.1001/jama.2016.0287.
    [12]
    ZHENG RQ, ZHANG YF, RONG ZQ, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021, interpretation and expectation[J]. Chin Critical Care Med, 2021, 33(10): 1159- 1164. DOI: 10.3760/cma.j.cn121430-20211009-01442.

    郑瑞强, 张艺芬, 荣子琪, 等. 《拯救脓毒症运动: 脓毒症与感染性休克治疗国际指南2021版》解读与展望[J]. 中华危重病急救医学, 2021, 33(10): 1159-1164. DOI: 10.3760/cma.j.cn121430-20211009-01442.
    [13]
    FLEISCHMANN-STRUZEK C, MIKOLAJETZ A, SCHWARZKOPF D, et al. Challenges in assessing the burden of sepsis and understanding the inequalities of sepsis outcomes between National Health Systems: secular trends in sepsis and infection incidence and mortality in Germany[J]. Intensive Care Med, 2018, 44(11): 1826-1835. DOI: 10.1007/s00134-018-5377-4.
    [14]
    HASSAN EA, ABDEL REHIM AS, AHMED AO, et al. Clinical value of presepsin in comparison to hsCRP as a monitoring and early prognostic marker for sepsis in critically ill patients[J]. Medicina (Kaunas), 2019, 55(2): 36. DOI: 10.3390/medicina55020036.
    [15]
    MILBRANDT EB, ELDADAH B, NAYFIELD S, et al. Toward an integrated research agenda for critical illness in aging[J]. Am J Respir Crit Care Med, 2010, 182(8): 995-1003. DOI: 10.1164/rccm.200904-0630CP.
    [16]
    SCHMITT F, MANOLOV V, MORGENSTERN J, et al. Acute fibrinolysis shutdown occurs early in septic shock and is associated with increased morbidity and mortality: results of an observational pilot study[J]. Ann Intensive Care, 2019, 9(1): 19. DOI: 10.1186/s13613-019-0499-6.
    [17]
    VAN VUGHT LA, UHEL F, DING C, et al. Consumptive coagulopathy is associated with a disturbed host response in patients with sepsis[J]. J Thromb Haemost, 2021, 19(4): 1049-1063. DOI: 10.1111/jth.15246.
    [18]
    BATES SM. D-dimer assays in diagnosis and management of thrombotic and bleeding disorders[J]. Semin Thromb Hemost, 2012, 38(7): 673-682. DOI: 10.1055/s-0032-1326782.
    [19]
    INNOCENTI F, GORI AM, GIUSTI B, et al. Prognostic value of sepsis-induced coagulation abnormalities: an early assessment in the emergency department[J]. Intern Emerg Med, 2019, 14(3): 459-466. DOI: 10.1007/s11739-018-1990-z.
    [20]
    BAKKER J. Lost in translation: on lactate, hypotension, sepsis- induced tissue hypoperfusion, quantitative resuscitation and surviving sepsis campaign bundles[J]. Crit Care Med, 2015, 43(3): 705-706. DOI: 10.1097/CCM.0000000000000870.
    [21]
    BOHRA A, WORLAND T, HUI S, et al. Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care[J]. World J Gastroenterol, 2020, 26(18): 2221-2231. DOI: 10.3748/wjg.v26.i18.2221.
    [22]
    KROUPINA K, BÉMEUR C, ROSE CF. Amino acids, ammonia, and hepatic encephalopathy[J]. Anal Biochem, 2022, 649: 114696. DOI: 10.1016/j.ab.2022.114696.
    [23]
    TRANAH TH, BALLESTER MP, CARBONELL-ASINS JA, et al. Plasma ammonia levels predict hospitalisation with liver-related complications and mortality in clinically stable outpatients with cirrhosis[J]. J Hepatol, 2022, 77(6): 1554-1563. DOI: 10.1016/j.jhep.2022.07.014.
    [24]
    ARORA V, MAIWALL R, RAJAN V, et al. Terlipressin is superior to noradrenaline in the management of acute kidney injury in acute on chronic liver failure[J]. Hepatology, 2020, 71(2): 600-610. DOI: 10.1002/hep.30208.
    [25]
    FEBRES ALDANA C, POPPITI RJ. Cholangitis lenta causing bile cast nephropathy: A unique model of hepatorenal failure in sepsis[J]. Fetal Pediatr Pathol, 2018, 37(6): 424-432. DOI: 10.1080/15513815.2018.1520945.
    [26]
    GINÈS P, FERNÁNDEZ J, DURAND F, et al. Management of critically-ill cirrhotic patients[J]. J Hepatol, 2012, 56 (Suppl 1): S13-24. DOI: 10.1093/ckj/sfac025.
    [27]
    BARLOW B, PONNALURI S, BARLOW A, et al. Targeting the gut microbiome in the management of sepsis-associated encephalopathy[J]. Front Neurol, 2022, 13: 999035. DOI: 10.3389/fneur.2022.999035.
    [28]
    ALI WA, BAZAN NS, ELBERRY AA, et al. A randomized trial to compare procalcitonin and C-reactive protein in assessing severity of sepsis and in guiding antibacterial therapy in Egyptian critically ill patients[J]. Ir J Med Sci, 2021, 190(4): 1487-1495. DOI: 10.1007/s11845-020-02494-y.
    [29]
    GREALISH M, CHIEW AL, VARNDELL W, Depczynski B. The relationship between admission glucose and lactate with critical illness amongst adult patients presenting to the emergency department[J]. Acta Diabetol, 2021, 58(10): 1343-1349. DOI: 10.1007/s00592-021-01725-7.
    [30]
    GÖK R, GÖK A, BULUT M. Assessing prognosis with modified early warning score, rapid emergency medicine score and worthing physiological scoring system in patients admitted to intensive care unit from emergency department[J]. Int Emerg Nurs, 2019, 43: 9-14. DOI: 10.1016/j.ienj.2018.06.002.
    [31]
    TANG R, SHI LP, WEI YY, et al. Correlation analysis of MEWS, length of stay in lCU and death of patients who were unplanned transferred to lCU before transfer[J]. Nursing Prac Res, 2022, 19(2): 179-183. DOI: 10.3969/j.issn.1672-9676.2022.02.005.

    唐蓉, 石兰萍, 魏莹莹, 等. 非计划性转入ICU患者转入前MEWS与ICU住院时长及死亡情况的相关性分析[J]. 护理实践与研究, 2022, 19(2): 179-183. DOI: 10.3969/j.issn.1672-9676.2022.02.005.
    [32]
    KHAN A, SARMA D, GOWDA C, et al. The Role of Modified Early Warning Score (MEWS) in the prognosis of acute pancreatitis[J]. Oman Med J, 2021, 36(3): e272. DOI: 10.5001/omj.2021.72.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(2)

    Article Metrics

    Article views (215) PDF downloads(53) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return