A prospective cohort-based prediction model incorporating acute gastrointestinal injury for 28-day and 90-day outcomes in acute decompensation of cirrhosis.

BACKGROUND AND AIMS: This prospective, observational study evaluated the role of acute gastrointestinal injury (AGI) in the 28-day and 90-day prognosis of cirrhotic patients with acute decompensation (AD).

METHODS

The baseline clinical characteristics of AD patients (N = 231) were recorded, and gastrointestinal function (GIF) was assessed. The patients were divided into three AGI groups based on their AGI grade (according to the European Society of Intensive Care Medicine guidelines), and they were followed for 90 days or until either death or liver transplantation.

RESULTS

During the 90-day follow-up period, 63 patients (22.27%) died and 2 (0.87%) underwent liver transplantation. Cox regression analyses identified endotoxin, creatinine, international normalized ratio (INR), infection status, and the occurrence of AGI as independent predictors of 28-day and 90-day death or transplantation. These five predictors were entered into the final Cox regression model to construct predictive models for 28-day (AGIM28) and 90-day (AGIM90) outcomes. Corresponding nomograms were subsequently developed. Of six prognostic models, the AGIM models had the highest prediction efficiency. In the Kaplan-Meier survival curve analysis, the 90-day cumulative survival rate of the three AGI groups (no-AGI, AGI 1, and AGI 2) decreased gradually (P < 0.001). Multivariate logistic analysis showed that d-lactate, bilirubin, INR, and bowel sounds were independent predictors of AGI progression.

CONCLUSION

Our novel prediction models, the AGIM28 and AGIM90, can effectively predict the 28-day and 90-day death or transplantation risk of cirrhotic patients with AD. The presence of AGI plays an undeniable role in the poor prognosis of AD patients.