A predictive nomogram incorporating gait speed for all-cause mortality in hospitalized cirrhotics

ABSTRACT

Objectives

No tailored model incorporating physical frailty for 2-year mortality in cirrhosis is available for practitioners in general practice. Thus we aimed to develop a model based on laboratory results and physical frailty allowing clinicians for stratifying cirrhotics by using individual estimate.

Methods

One hundred and thirteen cases were assigned to the primary cohort, and all other 76 patients were regarded as the validation cohort. Multivariate Cox regression was performed, and a nomogram including five-meter gait speed (5MGS) were generated. The performance of the proposed model was assessed by C-index, calibration curve, and decision curve analysis (DCA).

Results

On multivariate analysis, the Model for End-Stage Liver Disease-Sodium, albumin and 5MGS were independent predictors for 2-year mortality in cirrhosis. A nomogram incorporating all these parameters achieved a C-index of 0.804 (95%CI, 0.731–0.877). The calibration curve implied optimal correspondence between the predicted survival and actual outcomes. Our model is useful in the clinical settings based on DCA. Similar results were observed in the validation cohort with a C-index of 0.796 (95%CI, 0.689–0.899). Moreover, 5MGS, as a surrogate of physical performance, significantly correlated with multiple domains of general frailty according to Frailty Index (our published data), including instrumental activities of daily living, self-reported health, social activity and falls.

Conclusion

In conclusion, the nomogram incorporating 5MGS may represent an individualized tool for predicting mortality in cirrhosis for primary care physicians.

KEYWORDS:

• Cirrhosis
• frailty
• gait speed
• general practice
• nomogram
• prognosis

Authors’ contributions

X.-Y.W., H.-J.F., Y.-Y.H. and C.S. designed the study, analyzed the data, and prepared the original draft. T.-M.Z., L.-H.M., L.L. and X.-F.F. conducted the study and edited the manuscript. B.-X.C. and J.Z. analyzed the data and reviewed the manuscript. Q.-X.Y., B.-M.W., X.-L.Z. and C.S. designed and monitored the study and made critical revisions of the manuscript. All authors have approved the final draft submitted.

Data sharing

No additional data available.

Declaration of financial/other relationships

The authors declare that they have no potential conflicts of interest concerning the research, authorship, and publication of this article. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Declaration of interest

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The authors received no financial support for the research, authorship, and publication of this article.