Recompensation factors for patients with decompensated cirrhosis: a multicentre retrospective case-control study

Abstract

Objectives: We aimed to evaluate recompensation factors among patients with decompensated cirrhosis.

Design: A multicentre retrospective case-control study was conducted. Data were collected from and compared between groups of patients with recompensated and acute decompensated cirrhosis. Univariable and multivariable logistic regressions were used to select indicators associated with recompensation among patients with decompensated cirrhosis with different complications. A decision tree with 10-fold cross-validation was used to develop the model to identify patients with recompensation. We followed the transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD) guideline for development and reporting of the new model.

Setting: The study was conducted in six tertiary public hospitals in Chongqing, China.

Participants: This study included 3953 patients with decompensated cirrhosis.

Results: In the total sample of included patients, there were 553 patients with recompensation and 3400 patients with acute decompensation, including 1158 patients with gastrointestinal bleeding, 1715 patients with a bacterial infection, 104 patients with hepatic encephalopathy and 423 patients with ascites. The most relevant indicator of recompensation selected by the decision tree model was albumin, with a threshold of 40 g/L. Total protein, haemoglobin, basophil percentage, alanine aminotransferase, neutrophil-to-lymphocyte ratio and diabetes were also selected to subsequently distinguish patients. The terminal nodes with a probability of recompensation was 0.89. The overall accuracy rate of the model was 0.92 (0.91-0.93), and it exhibited high specificity (86.9%) and sensitivity (92.6%).

Conclusions: The occurrence of recompensated cirrhosis could be identified by albumin, total protein, haemoglobin, basophil percentage, alanine aminotransferase, neutrophil-to-lymphocyte ratio and diabetes. These simple variables may help clinicians develop a treatment plan to encourage patients with decompensated cirrhosis to recompensate.

Keywords: hepatobiliary disease; hepatology; risk management.

Figure 1

Decision tree plot for identifying recompensated cirrhosis. Each node shows the percentage of patients classified and their probability of recompensation (also represented by the colours and colour intensity). The blue colour represents acute decompensated cirrhosis. The green colour represents recompensated cirrhosis. The intensity of the colour indicates the accuracy of the classification of each category, the more intense the colour, the higher the accuracy.