Mortality predicting model in liver cirrhotic patients

Raluca Lupusoru¹, Ioan Sporea¹, Alina Popescu¹, Roxana Sirli¹, Mirela Danila¹, Ana-Maria Stepan¹, Anda Pascaru¹, Andreea Barbulescu¹, Iulia Ratiu¹

¹Department of Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Romania

Key worlds: liver cirrhosis, mortality, predicting model, mortality score

Backgound and aim

Cirrhotic patients came very often to hospital and need to be hospitalized and it is know that they have a higher rate of mortality.

The aim of the study was to assess the factors associated with the mortality among liver cirrhotic patients and to create a new score for predicting the mortality.

Material and methods

The study was retrospective, and we included all hospitalized patients with the final diagnosis of liver cirrhosis on a period of 7 years. We divide them in an initial group who will be analysed and in control group cohort, in witch we will validate the score. We performed univariate and multivariate analysis in order to determine a prediction model for the mortality.

Results

A total of 1163 cirrhotic patients were included in the study. In hospital mortality rate was 10%. Initial cohort contained 899 patients. Regarding cirrhosis etiology: 384/899 (42 %) had hepatitis C, 158/899 (17.5%) had hepatitis B, 293/899 (32.5%) werealcoholic, 6/899 (0.6 %) were autoimmune, 7/899 (0.7 %) were cardiac, 13/899 (1.4 %) were biliary and in 5 % of cases the etiology was unknown. In univariate analysis, hyponatremia (p<0.0001), hyperpotasemia (p<0.0001), hypoalbuminemia (p<0.0001), high values of bilirubin (p<0.0001), high values of creatinine (p<0.0001) were strongly associate with in hospital mortality. In multivariate analysis, the model including albumin, sodium, potassium, creatinine and bilirubin (all p-values <0.05) had an AUROC 0.78, CI (0.75-0.81), p<0.0001. Using this factors as predictors, by multiple regression analysis we obtained in the initial group the following score: ABCPS score=0.04+0.03*Albumin+0.05+0.02*Creatinine+0.04+0.04*Bilirubin+0.05+0.28* Potassium=0.04*0.07*Sodium. We validated the score on 264 patients (the control group). The optimal cut-off was >1.2, Se=62.9 %, Sp=73.4 %, PPV=21.3 %, NPV=94.6% (AUROC=0.72, p<0.0001).

Conclusion

Prevention and prompt treatment of kidney injury, hyponatremia, hyperpotassemia, can improve survival. ABCPS score is an accurate preditor of the mortality in liver cirrhosis.

Model de predictieamortalitatii la pacientiicucirozahepatica

Raluca Lupusoru¹, Ioan Sporea¹, Alina Popescu¹, Roxana Sirli¹, Mirela Danila¹, Ana-Maria Stepan¹, Anda Pascaru¹, Andreea Barbulescu¹, Iulia Ratiu¹

¹Department of Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, "Victor Babeş" University of Medicine and Pharmacy Timişoara, Romania

Cuvintecheie: ciroza hepatica, mortalitate, model predictiv, scormortalitate

Introducere si scop

Pacientiicirotici vin foarte des in spital si au nevoie sa fie hospitalizati si este cunoscuta rata foartecrescuta a mortalitatii in randullor. Scopulacestuistudiu a fostacela de a identificafactoriiasociaticumortalitatea in randulpacientiilorcuciroahepatica si de a crea un nouscor de predictie a mortalitatii.

Material si metode

Studiul a fostunulretrospectiv si a inclus totipacientiiinternati in Clinica de Gastroenterologie Timisoara pe o perioada de 7 ani. Am impartit pacientiiintr-un grup initial care va fi analizat si un grup de control, pe care vom valida scorul. Am facutanalizaunivariata si multivariatapentru a determinamodelul de predictie al mortalitatii.

Rezultate

Un total de 1163 pacienti au fostinclusi in studiu. Mortalitateaintraspitaliceasca a fost de 10 %. Cohortainitiala a continut 899 pacienti. In ceea ce privesteetiologia: 42 % au fostcuvirusul C, 17.5 % cuvirusul B, 32.5% au fostetanolici, 0.6 % autoimune, 0.7% cardicace, 1.4 % biliare si 5 % de etiologienecunoscuta. In analizaunivariatahiponatremia, hipopotasemia, hipoalbuminemia, valoareacrescuta a bilirubinei si valoareacrescuta a creatininei au fostextrem de asociatecumortalitateaintraspitaliceasca (p<0.0001). In analizamultivariata, modelulobtinutdinalbumina, sodiu, potasiu, creatinina si bilirubina (toate p<0.05) au avut AUROC 0.78, CI (0.75-0.81), p<0.0001.

Utilizandfactorii ca sipredictori, cu ajutorulregresiei am obtinuturmatorulscor: scorul ABCPS=0.04+0.03*Albumina+0.05+0.02*creatinina+0.04+0.04*bilirubina+0.05+0.28* potasiu=0.04*0.07*Sodiu. Am validatscorul de o cohort de 264 pacienti (grupul control).Valoarea cut-off optima a fost >1.2, Se=62.9 %, Sp=73.4 %, PPV=21.3 %, NPV=94.6% (AUROC=0.72, p<0.0001).

Concluzie

Preventia si tratametulpromt al insuficienteirenale, hiponatremiei, hiperpotasemiei pot imbunatatiisupravietuirea. Scorul ABCPS este un predictoracurat al mortalitatii in cirozahepatica.