Novel nomogram model for predicting 6‐week mortality in liver cirrhosis patients with acute upper gastrointestinal bleeding

• Published in: Journal of digestive diseases 2022-08, Vol.23 (8-9), p.516-526
• Main Authors: Zhou, Yu Fen, Xu, Ying, Ding, Yan Fei, Yu, Xiao Jun, Wu, Yun Lin, Chen, Ping, Zou, Duo Wu
• Format: Article
• Language: English
• Subjects: 6‐week mortality; Bilirubin; Bleeding; Child–Pugh score; Cirrhosis; Hemoglobin; Hepatic encephalopathy; Leukocytes (neutrophilic); Liver cirrhosis; Liver diseases; Lymphocytes; model for end‐stage liver disease score; Mortality; neutrophil‐to‐lymphocyte ratio; Nomograms; Prothrombin; Statistical sampling
• ISSN: 1751-2972; 1751-2980
• DOI: 10.1111/1751-2980.13137

Objective To develop and validate a nomogram for predicting 6‐week mortality in patients with liver cirrhosis and acute upper gastrointestinal bleeding (UGIB) and to compare it with other commonly used scoring systems. Methods This retrospective study included cirrhotic patients with acute UGIB hospitalized between January 2013 and December 2020. Random sampling was used to divide patients into the training (n = 676) and validation cohorts (n = 291) at a 7:3 ratio. Multivariate logistic stepwise regression was used to establish a model for predicting 6‐week mortality. Multiple indicators were used to validate the nomogram, including the area under the receiver operating characteristic curve (AUROC), calibration curve, and decision curve analysis (DCA). Results In the training cohort, total bilirubin (TBIL) (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.22–2.50), hemoglobin (Hb) (OR 0.97, 95% CI 0.95–0.99), C‐reactive protein (OR 2.79, 95% CI 1.30–6.07), prothrombin time (OR 1.17, 95% CI 1.05–1.30), and hepatic encephalopathy (stage I–II: OR 4.15, 95% CI 1.73–9.61; stage III–IV: OR 19.6, 95% CI 5.33–76.8) were identified as independent factors of 6‐week mortality. The AUROC of the UGIB‐LC score was 0.873 (95% CI 0.820–0.927), which was higher than that of the Child–Pugh score (0.781), model for end‐stage liver disease score (0.766), and neutrophil‐to‐lymphocyte ratio (0.716). Conclusion The UGIB‐LC score is useful for predicting 6‐week mortality in patients with liver cirrhosis and acute UGIB, which is superior to the other three scoring systems. The nomogram of the upper gastrointestinal bleeding‐liver cirrhosis (UGIB‐LC) score was useful for predicting mortality in liver cirrhosis patients with acute upper gastrointestinal bleeding (UGIB). In this study we established and validated a 6‐week mortality risk prediction model for cirrhotic patients with acute UGIB. The UGIB‐LC score contains five variables, hepatic encephalopathy (HE; 1, stage I–II; 2, stage III–IV), hemoglobin (Hb; g/L), C‐reactive protein (CRP; 0,