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Development and validation of a prognostic model for patients with hepatorenal syndrome: A retrospective cohort study
BACKGROUND: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis with high mortality, which necessitates accurate clinical decision. However, studies on prognostic factors and scoring systems to predict overall survival of HRS are not enough. Meanwhile, a multicenter cohort study with a...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Baishideng Publishing Group Inc
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160623/ https://www.ncbi.nlm.nih.gov/pubmed/34092979 http://dx.doi.org/10.3748/wjg.v27.i20.2615 |
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author | Sheng, Xin-Yu Lin, Fei-Yan Wu, Jian Cao, Hong-Cui |
author_facet | Sheng, Xin-Yu Lin, Fei-Yan Wu, Jian Cao, Hong-Cui |
author_sort | Sheng, Xin-Yu |
collection | PubMed |
description | BACKGROUND: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis with high mortality, which necessitates accurate clinical decision. However, studies on prognostic factors and scoring systems to predict overall survival of HRS are not enough. Meanwhile, a multicenter cohort study with a long span of time could be more convincing. AIM: To develop a novel and effective prognostic model for patients with HRS and clarify new prognostic factors. METHODS: We retrospectively enrolled 1667 patients from four hospitals, and 371 eligible patients were finally analyzed to develop and validate a novel prognostic model for patients with HRS. Characteristics were compared between survivors and non-survivors, and potential prognostic factors were selected according to the impact on 28-d mortality. Accuracy in predicting 28-d mortality was compared between the novel and other scoring systems, including Model for End-Stage Liver Disease (MELD), Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), and Chinese Group on the Study of Severe Hepatitis B-Acute-on-Chronic Liver Failure (COSSH-ACLF). RESULTS: Five prognostic factors, comprised of gender, international normalized ratio, mean corpuscular hemoglobin concentration, neutrophil percentage, and stage, were integrated into a new score, GIMNS; stage is a binary variable defined by the number of failed organs. GIMNS was positively correlated with MELD, CLIF-SOFA, and COSSH-ACLF. Additionally, it had better accuracy [area under the receiver operating characteristic curve (AUROC): 0.830] than MELD (AUROC: 0.759), CLIF-SOFA (AUROC: 0.767), and COSSH-ACLF (AUROC: 0.759) in the derivation cohort (P < 0.05). It performed better than MELD and CLIF-SOFA in the validation cohort (P < 0.050) and had a higher AUROC than COSSH-ACLF (P = 0.122). CONCLUSION: We have developed a new scoring system, GIMNS, to predict 28-d mortality of HRS patients. Mean corpuscular hemoglobin concentration and stage were first proposed and found to be related to the mortality of HRS. Additionally, the GIMNS score showed better accuracy than MELD and CLIF-SOFA, and the AUROC was higher than that of COSSH-ACLF. |
format | Online Article Text |
id | pubmed-8160623 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Baishideng Publishing Group Inc |
record_format | MEDLINE/PubMed |
spelling | pubmed-81606232021-06-03 Development and validation of a prognostic model for patients with hepatorenal syndrome: A retrospective cohort study Sheng, Xin-Yu Lin, Fei-Yan Wu, Jian Cao, Hong-Cui World J Gastroenterol Retrospective Cohort Study BACKGROUND: Hepatorenal syndrome (HRS) is a severe complication of cirrhosis with high mortality, which necessitates accurate clinical decision. However, studies on prognostic factors and scoring systems to predict overall survival of HRS are not enough. Meanwhile, a multicenter cohort study with a long span of time could be more convincing. AIM: To develop a novel and effective prognostic model for patients with HRS and clarify new prognostic factors. METHODS: We retrospectively enrolled 1667 patients from four hospitals, and 371 eligible patients were finally analyzed to develop and validate a novel prognostic model for patients with HRS. Characteristics were compared between survivors and non-survivors, and potential prognostic factors were selected according to the impact on 28-d mortality. Accuracy in predicting 28-d mortality was compared between the novel and other scoring systems, including Model for End-Stage Liver Disease (MELD), Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), and Chinese Group on the Study of Severe Hepatitis B-Acute-on-Chronic Liver Failure (COSSH-ACLF). RESULTS: Five prognostic factors, comprised of gender, international normalized ratio, mean corpuscular hemoglobin concentration, neutrophil percentage, and stage, were integrated into a new score, GIMNS; stage is a binary variable defined by the number of failed organs. GIMNS was positively correlated with MELD, CLIF-SOFA, and COSSH-ACLF. Additionally, it had better accuracy [area under the receiver operating characteristic curve (AUROC): 0.830] than MELD (AUROC: 0.759), CLIF-SOFA (AUROC: 0.767), and COSSH-ACLF (AUROC: 0.759) in the derivation cohort (P < 0.05). It performed better than MELD and CLIF-SOFA in the validation cohort (P < 0.050) and had a higher AUROC than COSSH-ACLF (P = 0.122). CONCLUSION: We have developed a new scoring system, GIMNS, to predict 28-d mortality of HRS patients. Mean corpuscular hemoglobin concentration and stage were first proposed and found to be related to the mortality of HRS. Additionally, the GIMNS score showed better accuracy than MELD and CLIF-SOFA, and the AUROC was higher than that of COSSH-ACLF. Baishideng Publishing Group Inc 2021-05-28 2021-05-28 /pmc/articles/PMC8160623/ /pubmed/34092979 http://dx.doi.org/10.3748/wjg.v27.i20.2615 Text en ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. |
spellingShingle | Retrospective Cohort Study Sheng, Xin-Yu Lin, Fei-Yan Wu, Jian Cao, Hong-Cui Development and validation of a prognostic model for patients with hepatorenal syndrome: A retrospective cohort study |
title | Development and validation of a prognostic model for patients with hepatorenal syndrome: A retrospective cohort study |
title_full | Development and validation of a prognostic model for patients with hepatorenal syndrome: A retrospective cohort study |
title_fullStr | Development and validation of a prognostic model for patients with hepatorenal syndrome: A retrospective cohort study |
title_full_unstemmed | Development and validation of a prognostic model for patients with hepatorenal syndrome: A retrospective cohort study |
title_short | Development and validation of a prognostic model for patients with hepatorenal syndrome: A retrospective cohort study |
title_sort | development and validation of a prognostic model for patients with hepatorenal syndrome: a retrospective cohort study |
topic | Retrospective Cohort Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160623/ https://www.ncbi.nlm.nih.gov/pubmed/34092979 http://dx.doi.org/10.3748/wjg.v27.i20.2615 |
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