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Randomized Controlled Trial
. 2023 Jan 2;23(1):1.
doi: 10.1186/s12876-022-02618-x.

Establishment and evaluation of an early prediction model of hepatorenal syndrome in patients with decompensated hepatitis B cirrhosis

Shouhao Wang #  1   2 , Zhewen Zhou #  2 , Chengan Xu  2 , Hanzhu Chen  2 , Wenya Ren  2 , Xingdi Yang  2 , Qiaoqiao Yin  2 , Wei Zheng  2 , Hongying Pan  3
Affiliations
Randomized Controlled Trial

Establishment and evaluation of an early prediction model of hepatorenal syndrome in patients with decompensated hepatitis B cirrhosis

Shouhao Wang et al. BMC Gastroenterol. .

Abstract

Background and aim: In China, hepatorenal syndrome is a serious complication in the decompensated stage of hepatitis B cirrhosis, which requires early clinical intervention, so the early diagnosis of hepatorenal syndrome is crucial. This study establishes a new predictive model based on serum biomarkers for the early diagnosis of hepatorenal syndrome.

Methods: Patients with decompensated hepatitis B cirrhosis who met the inclusion and exclusion criteria were retrospectively enrolled. Patients were randomly assigned to the training dataset and validation dataset at a 7:3 ratio. Univariate and multivariate logistic regression analyses were used to screen the risk factors for hepatorenal syndrome. The identified risk factors were used to establish and verify a model.

Results: This study included 255 patients with decompensated hepatitis B cirrhosis, including 184 in the training group and 71 in the validation group. The multivariate logistic regression model was established in the training group and verified in the validation group. Logistic regression showed that hemoglobin (OR 0.938, 95% CI 0.908-0.969), total bilirubin (OR 1.014, 95% CI 1.008-1.021) and creatinine (OR 1.079, 95% CI 1.043-1.117) were independent risk factors for hepatorenal syndrome (P < 0.05). These were used to establish the model. In the training group and the validation group, the area under the ROC curve of the nomogram for the diagnosis of hepatorenal syndrome was 0.968 and 0.980, respectively.

Conclusion: The three serum biomarkers, including hemoglobin, total bilirubin and creatinine, can be used as independent early predictors of hepatorenal syndrome in patients with decompensated hepatitis B cirrhosis.

Keywords: Cirrhosis; Hepatitis B virus; Hepatorenal syndrome; Model; Predictors; Retrospective study.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram depicting the participant selection process
Fig. 2
Fig. 2
ROC curves of model values and early diagnosis models in patients with decompensated hepatitis B cirrhosis in the HRS group and the non-HRS group. A In the training set, the model value of the HRS group was significantly higher than that of the non-HRS group (t = 10.350, P < 0.0001). B In the validation set, the model value of the HRS group was significantly higher than that of the non-HRS group (t = 8.213, P < 0.0001). C In all patients, the model value in the HRS group was significantly higher than that in the non-HRS group (t = 11.830, P < 0.0001). D The ROC curve [area under the ROC curve (AUC)] of the model in the training set was 0.968. E ROC curve of the model in the validation set (AUC 0.980). F ROC curve of the model in all patients (AUC 0.969)
Fig. 3
Fig. 3
Nomo map based on the training group, calibration curve and decision curve based on the validation set. A Displaying the model with visual charts is more suitable for clinical application. B, C Validation of the nomogram prediction accuracy by building calibration curves using validation sets. D, E The decision curve of the validation set shows that the prediction model has obvious net benefits, indicating that the model has high clinical application value
Fig. 4
Fig. 4
Application of our model for the early prediction of decompensated hepatitis B cirrhosis patients with HRS symptomatic treatment algorithm
See this image and copyright information in PMC

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