https://orcid.org/0009-0003-3471-2639
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ABSTRACT
Background
Liaoning score has been developed and validated to predict the risk of esophageal varices in liver cirrhosis. This study aimed to further modify the Liaoning score by combining clinical and laboratory parameters to predict the long-term outcome of cirrhotic patients.
Methods
First, 474 cirrhotic patients were retrospectively enrolled from Shenyang, China as the training cohort. Independent predictors for death were identified by competing risk analyses, and then a new prognostic model, called as modified Liaoning score, was developed. Its performance was externally validated at three centers from Fuzhou, China (n = 1944), Jinan, China (n = 485), and São Paulo, Brazil (n = 221).
Results
Age, total bilirubin (TBIL), albumin (ALB), serum creatinine (SCr), and Liaoning score were independently associated with death in the training cohort. Modified Liaoning score = 0.159×Liaoning score + 0.010×TBIL(µmol/L)+0.029×age(years)+0.011×SCr(µmol/L)-0.037×ALB(g/L). The area under curve of modified Liaoning score was 0.714 (95%CI = 0.655–0.773), which was higher than that of Child-Pugh score (0.707, 95%CI = 0.645–0.770), MELD score (0.687, 95%CI = 0.623–0.751), and Liaoning score (0.583, 95%CI = 0.513–0.654). A modified Liaoning score of ≥ 1.296 suggested a higher cumulative incidence of death in liver cirrhosis (p < 0.001). Modified Liaoning score still had the highest prognostic performance in Chinese and Brazilian validation cohorts.
Conclusions
Modified Liaoning score can be considered for predicting the long-term outcome of cirrhotic patients.
GRAPHICAL ABSTRACT
Abbreviations
| ALB | = | albumin |
| AUC | = | area under curve |
| AIC | = | akaike information criterion |
| ALT | = | alanine aminotransferase |
| AST | = | aspartate aminotransferase |
| AKP | = | alkaline phosphatase |
| AUGIB | = | acute upper gastrointestinal bleeding |
| BIC | = | bayesian information criterion |
| CI | = | confidence interval |
| GGT | = | gamma-glutamyl transpeptidase |
| HBV | = | hepatitis B virus |
| HCV | = | hepatitis C virus |
| HE | = | hepatic encephalopathy |
| Hb | = | hemoglobin |
| INR | = | international normalized ratio |
| K | = | potassium |
| MELD | = | model for end-stage of liver disease |
| Na | = | sodium |
| Pts | = | patients |
| PLT | = | platelet |
| ROC | = | receiver operating characteristic |
| SD | = | standard deviation |
| SCr | = | serum creatinine |
| sHR | = | sub-distribution hazard ratio |
| TBIL | = | total bilirubin |
| WBC | = | white blood cell. |
Declaration of interest
The authors have no relevant， affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Reviewer disclosures
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Authors’ contributions
Conceptualization: X Qi. Data collection and revision: X Song, FG Romeiro, J Wang, Y Yin, CA Philips, X Yang, W Wu, X Liu, MVT Bernardinelli, R Souza, AH Theruvath, S Lin and X Qi. Data analysis: X Song, Y Yin, and X Qi. Methodology and writing: X Song, FG Romeiro, J Wang, Y Yin, CA Philips, S Lin, and X Qi. Critical comments and revision: X Song, FG Romeiro, J Wang, Y Yin, CA Philips, S Lin, and X Qi; Supervision: X Qi. All authors have made an intellectual contribution to the manuscript and approved the submission.
Acknowledgments
The authors are indebted to our study team, including H Deng, R Wang, J Li, Y Li, X Xu, Z Bai, Q Li, K Zheng, L Wang, F Yi, Y Wu, L Luo, Y Yin, S Xu, M Peng, W Wang, X Wang, Y Zhang, and X Zheng, for their efforts in establishing and updating the prospective database of liver cirrhosis from the General Hospital of Northern Theater Command. The authors express our gratitude to Y Ma, Z Yang, J Yuan, and all participants of other centers. M Bernardinelli and R Souza are grateful to the São Paulo Research Foundation (FAPESP) (Grant number 2022/07839-5) and to UNESP/VUNESP/SEE for the scholarships received.
Data availability statement
The datasets during the current study are available from the corresponding author on reasonable request.
Supplementary material
Supplemental data for this article can be accessed online at https://doi.org/10.1080/17474124.2024.2320238