Development and validation of a nomogram to predict recompensation in HBV-related cirrhosis with ascites as the single first decompensating event

Abstract

Background and objective

Little is known about the influencing factors for recompensation in HBV-related cirrhosis patients with ascites as the single first decompensating event and it’s necessary to build a prediction model for these patients.

Methods

Hepatitis B virus-related cirrhosis patients with ascites hospitalized for the first decompensation were included and they were divided into the training cohort (2010.03–2020.03) and the validation cohort (2020.04–2022.04). All patients received antiviral therapy within 3 months before admission or immediately after admission. Recompensation is defined as the patient’s ascites disappeared without diuretics, which were maintained for more than 1 year and no other decompensated complications, hepatocellular carcinoma, or liver transplantation occurred. The nomogram was developed from a training cohort of 279 patients and validated in another cohort of 72 patients.

Results

Totally, 42.7% of the decompensated patients achieved recompensation. According to the results of logistic regression and competing risk analysis, six independent factors associated with recompensation were found and these factors comprised the nomogram: age, alanine aminotransferase (ALT), albumin (ALB), serum sodium (Na), alpha-fetoprotein (AFP), and maintained virological response (MVR). Through external validation, the area under the receiver operating characteristic curve (AUC) of the nomogram was 0.848 (95% CI: 0.761, 0.936), which was significantly better than CTP, MELD, MELDNa, MELD 3.0, and ALBI grade.

Conclusions

Age, ALT, ALB, Na, AFP, and MVR are closely related to the recompensation. The nomogram developed based on these items can accurately predict the possibility of recompensation in hepatitis B cirrhosis patients with ascites as the single first decompensating event.

Keywords:

• Recompensation
• hepatitis B
• cirrhosis
• ascites
• nomogram

Authors contributions

Shifei Wen: statistical analysis, manuscript writing; Jiajia Ruan, Jiaming Shen: data collection; Xia Wang, Guangde Yang: writing guidance; Juanjuan Fu, Li Li: article revision; Xucheng Pan: article review and critical revision.

Ethical approval

The study protocol was approved by the Hospital Ethics Committee of the Affiliated Hospital of Xuzhou Medical University, Grant No. XYFY2020-KL052-01 and the ethical approval was granted on May 28, 2020. This study was conducted in accordance with the principles of the Declaration of Helsinki.

Disclosure statement

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

Additional information

Funding

Sub-topic on Prevention and Treatment of Major AIDS and Virus Hepatitis Infectious Diseases in the 13th Five-Year Plan and National Science and Technology Major Project (2018ZX10302-206).