Development And Validation Of A Predictive Model For In-hospital Mortality In Patients With Liver Cirrhosis And Sepsis

Objectives:The prognosis of patients with cirrhosis and sepsis is poor,especially those admitted to ICU.This study aimed to investigate the effect of liver cirrhosis on the prognosis of patients with sepsis,analyze the clinical characteristics and risk factors of in-hospital mortality in cirrhotic patients with sepsis,and construct and validate a predictive model for in-hospital mortality in cirrhotic patients with sepsis.Methods:Patients with sepsis admitted to the MICU from 2008 to 2019 were screened in the MIMIC-IV database and were divided into cirrhotic group and non-cirrhotic group.The effect of cirrhosis on the prognosis of sepsis was evaluated by multivariate analysis.To analyze the clinical characteristics of septic patients with liver cirrhosis,and determine the independent factors of inhospital mortality in septic patients with liver cirrhosis by univariate and multivariate analysis.Develop and validate the prediction model of in-hospital mortality in septic patients with liver cirrhosis,visualize the model with nomogram,and compare performances of nomogram with SOFA,SAPSII and MELD scores.Results:In total,4,230 septic patients were included in this study,of whom 836(19.8%)had liver cirrhosis.Multivariate analysis shows that liver cirrhosis is significantly associated with higher in-hospital mortality and ICU mortality in septic patients.Among septic patients with liver cirrhosis,the median non-liver SOFA score and SAPSII score were 8 and 40 respectively.The all-cause inhospital mortality and ICU mortality were 29.8% and 21.1% respectively.The most common infection site and pathogen were pulmonary infection and Staphylococcus aureus respectively.Heart rate(HR),blood urea nitrogen(BUN),prothrombin time(PT),total bilirubin(TB),serum lactate,acute renal injury(AKI),received mechanical ventilation and use of the vasopressors are independent risk factors for in-hospital mortality in patients with liver cirrhosis complicated with sepsis.Finally,the eight factors were selected,including age,use of the vasopressors,acute renal injury,blood creatinine,total bilirubin,prothrombin time,serum lactate and Glasgow score,and a nomogram for in-hospital mortality risk in septic patients with liver cirrhosis was constructed.In the derivation cohort and validation cohort,performance of the nomogram with an area under the curve(AUC)value of 0.871(95%CI: 0.842-0.900)and 0.866(95%CI: 0.813-0.919)respectively,which were better than SOFA,SAPSII and MELD(all P<0.05).Conclusion:Liver cirrhosis is a common population of septic patients in MICU and is associated with poor short-term prognosis.Septic patients with liver cirrhosis usually have severe organ dysfunction and high mortality.Factors prediction of in-hospital mortality depend mainly on the severity of liver dysfunction and the critical event as reflected by non-liver SOFA score.The nomogram established for septic patients with liver cirrhosis has good performance and certain clinical value.