| ObjectiveTo explore the predictive model of early diagnosis of decompensated hepatitis B cirrhosis complicated with hepatorenal syndrome(HRS)based on serum biomarkers,and to provide a basis for early assessment and treatment of HRS patients.MethodsPatients diagnosed with decompensated hepatitis B cirrhosis in******Hospital from January 2015 to January 2023 were selected.General demographic data,laboratory indicators,diuretic use,complications and end-stage liver disease model scores were collected.According to the ratio of 7:3,the patients were randomly divided into training group and verification group,and the clinical data of the two groups were compared to test whether there was a statistically significant difference Independent t test and non-parametric test were used to compare quantitative variables,and chi-square test was used to test the differences between various categorical variables.Variables with statistical differences in univariate logistic regression analysis were introduced into multivariate stepwise logistic regression to establish an early HRS prediction model in the training group.The accuracy of the model for early prediction of HRS was evaluated by the area under the receiver operating characteristic(ROC)curve(AUC)Welch-corrected t test was used to analyze the model values of the HRS group and the non-HRS group in the training set,validation set and the whole population.The correction curve and decision curve evaluation model are used.ResultsThis study included 255 patients with decompensated hepatitis B cirrhosis,46 patients with decompensated hepatitis B cirrhosis with HRS,and 209 patients without HRS.According to the ratio of 7:3,all patients were randomly divided into training group(n=184)and validation group(n=71)for experimental study After comparison,there was no significant statistical difference between the variables of the training group and the verification group(P<0.05).With HRS as the dependent variable,through univariate logistic regression analysis,we found that white blood cell(WBC),neutrophil to lymphocyte ratio(NLR),hemoglobin(Hb),globulin(GLB),total bilirubin(TB),urea nitrogen(BUN),creatinine(Cr),sodium ion(Na+),prothrombin time(PT),international standardized ratio(APTT)and bacterial infection may be the influencing factors of HRS(P<0.05).The independent variables with statistical difference(P<0.05)in univariate logistic regression were included in multivariate logistic regression.The results showed that Hb,TB and Cr were independent risk factors for HRS in patients with decompensated hepatitis B cirrhosis(P<0 05).The corresponding predictive model was constructed(hemoglobin is in g/L,total bilirubin is in μmol/L,and creatinine is inμmol/L):Model=-0.064 × Hb+0.014× TB+0.076 ×Cr-3.802.In the training group(t=10.350,P<0.0001),the validation group(t=8.213,P<0.0001)and the total group(t=11.830,P<0.0001),the model score of the HRS group was significantly higher than that of the non-HRS group.Based on ROC analysis,the optimal cut-off value of the model was calculated(0.146).A higher cut-off value(>0.146)to determine which patients with HRS need symptomatic treatment.A lower cut-off value(<0.146)was used to determine whether patients without HRS could be followed up regularly In the training group,when the critical value of the model was 0.146,22 patients(62.9%)were recommended to start symptomatic treatment and 13 patients were followed up regularly.Among the 46 patients with decompensated hepatitis B cirrhosis and HRS in the whole population,30(65.2%)could be treated early according to the critical value.The area under the ROC curve(AUC)of the training group and the validation group was 0.968 and 0.980,respectively.Compared with the MELD model(AUC=0.896),the AUC value of the prediction model established in this study was higher.In order to facilitate clinical application,this study established a nomogram that can more intuitively express the relationship between the three variables in the prediction model The decision curve and correction curve of the training group and the validation group suggest that the prediction model has high clinical application value and meets the actual needs of clinical decision-making.ConclusionThis study showed that Hb,TB and Cr were independent risk factors for hepatorenal syndrome in patients with decompensated hepatitis B cirrhosis A simple,rapid,personalized and accurate diagnostic method for HRS is provided by the line chart established by serological indicators and is worthy of application in clinical trials... |
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