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. 2021 Sep 27:2021:4073503.
doi: 10.1155/2021/4073503. eCollection 2021.

Nomogram to Predict the Survival of Chinese Patients with Alcohol-Related Liver Disease

Fangfang Duan  1 , Chen Liu  1 , Yuwei Liu  1 , Chunyan Chang  1 , Hang Zhai  1 , Huichun Xing  1 , Jun Cheng  1 , Song Yang  1   2
Affiliations

Nomogram to Predict the Survival of Chinese Patients with Alcohol-Related Liver Disease

Fangfang Duan et al. Can J Gastroenterol Hepatol. .

Abstract

Objectives: Alcohol-related liver disease is an increasing public health burden in China, but there is a lack of models to predict its prognosis. This study established a nomogram for predicting the survival of Chinese patients with alcohol-related liver disease (ALD).

Methods: Hospitalized alcohol-related liver disease patients were retrospectively enrolled from 2015 to 2018 and followed up for 24 months to evaluate survival profiles. A total of 379 patients were divided into a training cohort (n = 265) and validation cohort (n = 114). Cox proportional hazard survival analysis identified survival factors of the patients in the training cohort. A nomogram was built and internally validated.

Results: The 3-month, 6-month, 12-month, and 24-month survival rates for the training cohort were 82.6%, 81.1%, 74.3%, and 64.5%, respectively. The Cox analysis showed relapse (P=0.001), cirrhosis (P=0.044), liver cancer (P < 0.001), and a model for end-stage liver diseases score of ≥21 (P=0.041) as independent prognostic factors. A nomogram was built, which predicted the survival of patients in the training cohort with a concordance index of 0.749 and in the internal validation cohort with a concordance index of 0.756.

Conclusion: The long-term survival of Chinese alcohol-related liver disease patients was poor with a 24-month survival rate of 64.5%. Relapse, cirrhosis, liver cancer, and a model for end-stage liver disease score of ≥21 were independent risk factors for those patients. A nomogram was developed and internally validated for predicting the probability of their survival at different time points.

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Conflict of interest statement

None of the authors have any conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart of the study's design.
Figure 2
Figure 2
Kaplan–Meier estimate of the ALD patients stratified by cohort. AH/No ALC: patients with alcoholic hepatitis and without cirrhosis due to alcohol-related liver disease; No AH/No ALC: patients with neither alcoholic hepatitis nor cirrhosis due to alcohol-related liver disease; No AH/ALC: patients with cirrhosis due to alcohol-related liver disease and without alcoholic hepatitis; and AH/ALC: patients with both alcoholic hepatitis and cirrhosis due to alcohol-related liver disease. Kaplan–Meier curves for survival of patients with AH and without AH in the training cohort (a); Kaplan–Meier curves for survival of patients with ALC and without ALC in the training cohort (b); patients were divided into four groups, namely, AH/No ALC, No AH/No ALC, No AH/ALC, and AH/ALC. Kaplan–Meier curves for survival of the patients in the training cohort (c); Kaplan–Meier curves for survival of the patients with liver cancer and without liver cancer in the training cohort (d); Kaplan–Meier curves for survival of patients who followed abstinence and relapsed from abstinence in the training cohort (e); Kaplan–Meier curves for survival of the patients with MELD score ≥21 and with MELD <21 in the training cohort (f); Kaplan–Meier curves for survival of the patients in the training cohort and validation cohort (g).
Figure 3
Figure 3
A nomogram for predicting 3-month, 6-month, and 12-month survival of ALD patients. The nomogram was established based on the training cohort.
Figure 4
Figure 4
Calibration curve of the nomogram predicting 3-month, 6-month, and 12-month survival rates in the training cohort (a). Calibration curve of the nomogram predicting 3-month, 6-month, and 12-month survival rates in the validation cohort (b).
See this image and copyright information in PMC

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