Value Of ALBI-based Nomogram Analysis In Prognostic Model Of Decompensated Patients With Hepatitis B Cirrhosis

Objective To investigate whether the albumin-bilirubin score(ALBI)can be used for the prognosis evaluation of patients with decompensated hepatitis B liver cirrhosis,and to produce a comprehensive,accurate and intuitive Nomogram diagram for routine evaluation by clinicians.Methods(1)The medical records and laboratory results of patients with decompensated hepatitis B cirrhosis treated in Yichang Central people’s Hospital from January 2015 to January 2017 were analyzed retrospectively,and the subjects in accordance with this study were followed up by telephone.The follow-up time was 3 months,6 months,1 year,2 years and 3 years after admission,and the end point was death.(2)Descriptive analysis of the general characteristics of the 3-year survival and death groups.(3)Evaluate the independent risk factors that affect the patient’s death through multivariate analysis,establish Nomogram and test and correct it.In addition,we compared the predictive efficacy of ALBI with classical score,including Child-Turcotte-Pugh(CTP)and end-stage liver disease model score(MELD),as well as the newly proposed assessment index---neutrophil to lymphocyte ratio(NLR).Results(1)The level of ALBI in the dead group is significantly higher than that in the survival group.The patients with ALBI grade 1 have the longest survival time,whose median survival time is 35.9(95%CI:35.841-36.050)months.The second is patients with ALBI grade 2 with the median survival time of 30.0(95%CI:27.731-32.379)months.The patients with ALBI grade 3 had the shortest survival time with a median survival time of 26.4(95%CI:23.056-29.755)months.(2)ALBI grade,CTP grade,MELD score,HBV-DNA,NLR,antiviral therapy and infection are independent factors affecting the prognosis of patients with decompensated hepatitis B cirrhosis.(3)compared with the classical score----Child-Turcotte-Pugh,model score of end-stage liver disease----and the newly proposed evaluation index,neutrophil / lymphocyte ratio,ALBI can achieve almost the same predictive efficiency.Although the area under the 3-year survival curve of the four groups is less than 0.7.(4)the establishment of Nomogram can intuitively and quickly evaluate the 3-month mortality of patients with decompensated hepatitis B cirrhosis,which is proved to be good accuracy through internal verification.Conclusion ALBI can evaluate the prognosis of patients with decompensated hepatitis B cirrhosis in the past two years.The higher the ALBI grade,the higher the mortality.ALBI grade,CTP grade,MELD score and NLR are independent factors to evaluate the survival prognosis of patients with decompensated hepatitis B cirrhosis,but the accuracy of the four scores for long-term(3 years)survival evaluation is low.Clinicians can evaluate the 3-month survival prognosis of newly admitted patients with decompensated hepatitis B cirrhosis according to their ALBI grade,CTP grade,MELD score,HBV-DNA,NLR,antiviral therapy or infection through Nomogram diagram.