Development and validation of a practical prognostic nomogram for evaluating inpatient mortality of cirrhotic patients with acute variceal hemorrhage

Jie Chen; Sha Luo; Feng Tang; Ming Han; Jie Zheng; Mingming Deng; Gang Luo

doi:10.1016/j.aohep.2023.101086

Development and validation of a practical prognostic nomogram for evaluating inpatient mortality of cirrhotic patients with acute variceal hemorrhage

Ann Hepatol. 2023 May-Jun;28(3):101086. doi: 10.1016/j.aohep.2023.101086. Epub 2023 Mar 6.

Authors

Jie Chen¹, Sha Luo², Feng Tang³, Ming Han¹, Jie Zheng¹, Mingming Deng⁴, Gang Luo⁵

Affiliations

¹ Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
² Department of Laboratory Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China.
³ Department of Gastroenterology, Third People's Hospital of Chengdu, Chengdu, Sichuan, China.
⁴ Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China. Electronic address: dengmingming@swmu.edu.cn.
⁵ Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China. Electronic address: gangluo820@126.com.

PMID: 36889674
DOI: 10.1016/j.aohep.2023.101086

Abstract

Introduction and objectives: Cirrhotic patients with acute variceal hemorrhage (AVH) have high short-term mortality. Established prognostic scores are seldom applicable clinically, partially because they need external validation or contain subjective variables. We aimed to develop and validate a practical prognostic nomogram based on objective predictors to predict prognosis for cirrhotic patients with AVH.

Patients and methods: We enrolled 308 AVH patients with cirrhosis from our center as the derivation cohort to develop a new nomogram using logistic regression and validated it in cohorts of patients from Medical Information Mart for Intensive Care (MIMIC) III (n = 247) and IV (n = 302).

Results: International normalized ratio (INR), albumin (ALB) and estimated glomerular filtration rate (eGFR) were identified as predictors for inpatient mortality and a nomogram was constructed based on them. The nomogram discriminated well in both derivation and MIMIC-III/-IV validation cohorts with the area under the receiver operating characteristic curves (AUROCs) of 0.846 and 0.859/0.833, respectively and showed a better agreement between expected and observed outcomes (Hosmer-Lemeshow tests, all comparisons, P > 0.05) than other scores in all cohorts. Our nomogram had the lowest Brier scores (0.082/0.114/0.119 in training/MIMIC-III/MIMIC-IV) and highest R² (0.367/0.393/0.346 in training/MIMIC-III/MIMIC-IV) compared to the recalibrated model for end-stage liver disease (MELD), MELD-hepatic encephalopathy (MELD-HE) and cirrhosis acute gastrointestinal bleeding (CAGIB) scores in all cohorts.

Conclusions: We developed a practical prognostic nomogram using easily verified indicators available in initial patient evaluation, which may serve as a reliable tool to accurately predict inpatient mortality for cirrhotic patients with AVH.

Keywords: Acute variceal hemorrhage; Inpatient mortality; Liver cirrhosis; Nomogram.

MeSH terms

End Stage Liver Disease* / complications
Esophageal and Gastric Varices* / complications
Esophageal and Gastric Varices* / etiology
Gastrointestinal Hemorrhage / diagnosis
Gastrointestinal Hemorrhage / etiology
Humans
Inpatients
Liver Cirrhosis / complications
Liver Cirrhosis / diagnosis
Nomograms
Prognosis
Retrospective Studies
Severity of Illness Index