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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 40 Issue 11
Nov.  2024
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Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(11): 2221-2228

Risk factors for death within 30 days after admission in patients with decompensated liver cirrhosis and acute kidney injury and construction of a nomogram model

DOI: 10.12449/JCH241115
  • 1.

    Department of Gastroenterology，The First Affiliated Hospital of Nanchang University，Nanchang 330006，China

  • 2.

    Department of Gastroenterology，Shenzhen Hospital，Southern Medical University，Shenzhen，Guangdong 518101，China

  • 3.

    Shenzhen Clinical Research Center for Digestive Diseases，Shenzhen，Guangdong 518101，China

Research funding:

National Natural Science Foundation of China (82160115);

Project of Science and Technology Department of Jiangxi Province (20202BBGL73093)

More Information
  • Corresponding author: WANG Anjiang， waj1103@163.com （ORCID： 0000-0001-6670-6645）
  • Received Date: 2024-02-25
  • Accepted Date: 2024-03-29
  • Published Date: 2024-11-25
    Abstract
  •   Objective  To investigate the predictive factors for death within 30 days after admission in patients with decompensated liver cirrhosis and acute kidney injury （AKI）， and to establish and validate a nomogram prediction model.  Methods  The Joint Medical Record Management System of The First Affiliated Hospital of Nanchang University was used to obtain the patients with decompensated liver cirrhosis who were hospitalized in Department of Gastroenterology and Department of Infectious Diseases from January 2015 to December 2020， among whom 330 patients who met the 2015 International Club of Ascites diagnostic criteria for AKI were enrolled and divided into training group with 193 patients and validation group with 137 patients. A Cox regression analysis was used to investigate the predictive factors for death， and then a nomogram prediction model for the risk of death within 30 days after admission was established and validated. The independent-samples t-test was used for comparison of normally distributed continuous data between two groups， and a one-way analysis of variance was used for comparison between multiple groups， while the least significant difference t-test was used for further comparison between two groups； The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups， while the Kruskal-Wallis H test was used for comparison between multiple groups. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups.  Results  The prevalence rate of AKI was 16.5% in patients with decompensated liver cirrhosis. The 330 patients included in the study had a mean age of 53.6±12.4 years， and male patients accounted for 79.1%. The mortality rate was 50.0% within 30 days after admission， with a mortality rate of 46.6% in the training group and 54.7% in the validation group. The presence of acute-on-chronic liver failure （ACLF） on admission was an independent risk factor for the progression of AKI into stage 1 （odds ratio=2.571， 95% confidence interval： 1.143‍ ‍—‍ ‍5.780， P=0.022）. The nomogram based on white blood cell count， international normalized ratio， presence or absence of hepatic encephalopathy， and AKI stage on admission could well predict the risk of death with 30 days after admission， with a C-index of 0.680 in the training group and 0.683 in the validation group， and it was not inferior to CTP score and MELD score.  Conclusion  ACLF is an independent risk factor for the progression of AKI into stage 1. The nomogram prediction model established in this study can effectively predict the risk of death within 30 days after admission and thus has important guiding significance for the early identification and management of patients with decompensated liver cirrhosis and AKI.

     

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