Construction and validation of nomogram model for risk of hepatic encephalopathy induced by HBV-related patients with chronic and acute liver failure

doi:10.3877/cma.j.issn.2095-2015.2025.02.009

Abstract

Abstract:

Objective

To establish a nomogram model of the risk of hepatic encephalopathy induced by hepatitis B virus （HBV）-related chronic and acute liver failure （HBV-ACLF） and verify its clinical application efficiency.

Methods

A total of 464 patients with HBV-ACLF admitted to Qingdao Eighth People's Hospital from January 2020 to January 2024 were enrolled in the training set （n=325） and the verification set （n=139） according to the ratio of 7∶3. According to the occurrence of hepatic encephalopathy in the training set，the patients were divided into the occurrence group and the non-occurrence group，and the clinical data of the two groups were compared. Logistic multivariate model was used to summarize the risk factors affecting the occurrence of hepatic encephalopathy in HBV-ACLF patients，and nomogram prediction model was established based on the risk factors. The prediction model was applied to the verification set，and the receiver operating characteristic curve （ROC） was plotted to analyze the area under curve （AUC） and prediction efficiency of the prediction model.

Results

Among the 325 patients in the training set，72 patients developed hepatic encephalopathy，the incidence rate was 22.15%. Among the 139 patients in the verification set，29 cases developed hepatic encephalopathy，with an incidence rate of 20.86%. Logistic multivariate regression analysis showed that model of end-stage liver disease （MELD） score≥25，peritonitis，international normalized ratio≥2.54，activated partial thromboplastin time≥48.10 s，and illness in the middle to late stage were all independent risk factors for HBV-ACLF patients to induce hepatic encephalopathy （P＜0.05）. DCA curve showed that the nomogram model showed good clinical net benefit in both training set and verification set. Taking the total score≥117 as the cut-off value，the AUC of the nomogram model in predicting the occurrence of hepatic encephalopathy in the training set and the verification set was 0.957 and 0.899，respectively，with sensitivity of 95.83% and 89.66%，specificity of 95.65% and 90.00%，respectively. Delong test showed that the predictive value of nomogram model was higher than ACLF score （Z=2.594） and MELD score （Z=3.113）（P＜0.05）.

Conclusion

The risk of hepatic encephalopathy in HBV-ACLF patients is high，and it is closely related to the condition，symptoms，coagulation function and other factors. The nomogram model based on the above factors can provide reliable reference for the risk assessment of hepatic encephalopathy in patients.

Key words: Chronic acute liver failure, Hepatic encephalopathy, Hepatitis B virus, Nomogram model

Haili Fang, Jun Wang, Lin Luan. Construction and validation of nomogram model for risk of hepatic encephalopathy induced by HBV-related patients with chronic and acute liver failure[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(02): 144-148.

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Figures/Tables 7

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ± s ）	BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）	MELD 评分（ $\overset{ˉ}{x}$ ± s ）	白蛋白（g/L， $\overset{ˉ}{x}$ ± s ）	肌酐（μmol/LALB）	性别［例（%）］		症状［例（%）］		使用镇静剂［例（%）］	消化道出血［例（%）］
组别	例数	年龄（岁， $\overset{ˉ}{x}$ ± s ）	BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）	MELD 评分（ $\overset{ˉ}{x}$ ± s ）	白蛋白（g/L， $\overset{ˉ}{x}$ ± s ）	肌酐（μmol/LALB）	男	女	腹水	腹膜炎	使用镇静剂［例（%）］	消化道出血［例（%）］
训练集	325	44.71±5.96	22.23±1.31	24.41±3.08	31.33±2.85	68.11±5.94	267（82.15）	58（17.85）	124（38.15）	201（61.85）	10（3.08）	22（6.77）
验证集	139	44.58±5.24	22.31±1.16	24.26±2.75	31.46±2.71	68.26±6.17	111（79.86）	28（20.14）	56（40.29）	103（74.10）	4（2.88）	12（8.63）
t/χ ² 值		0.223	0.623	0.496	0.457	0.246	0.340		0.187		0.033	0.498
P 值		0.824	0.534	0.620	0.648	0.806	0.560		0.666		0.856	0.480

组别	例数	年龄（岁， $\overset{ˉ}{x}$ ± s ）	BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）	MELD 评分（ $\overset{ˉ}{x}$ ± s ）	白蛋白（g/L， $\overset{ˉ}{x}$ ± s ）	肌酐（μmol/LALB）	性别［例（%）］		症状［例（%）］		使用镇静剂［例（%）］	消化道出血［例（%）］
组别	例数	年龄（岁， $\overset{ˉ}{x}$ ± s ）	BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）	MELD 评分（ $\overset{ˉ}{x}$ ± s ）	白蛋白（g/L， $\overset{ˉ}{x}$ ± s ）	肌酐（μmol/LALB）	男	女	腹水	腹膜炎	使用镇静剂［例（%）］	消化道出血［例（%）］
训练集	325	44.71±5.96	22.23±1.31	24.41±3.08	31.33±2.85	68.11±5.94	267（82.15）	58（17.85）	124（38.15）	201（61.85）	10（3.08）	22（6.77）
验证集	139	44.58±5.24	22.31±1.16	24.26±2.75	31.46±2.71	68.26±6.17	111（79.86）	28（20.14）	56（40.29）	103（74.10）	4（2.88）	12（8.63）
t/χ ² 值		0.223	0.623	0.496	0.457	0.246	0.340		0.187		0.033	0.498
P 值		0.824	0.534	0.620	0.648	0.806	0.560		0.666		0.856	0.480

临床资料		发生组（n=72）	未发生组（n=253）	t/χ ² 值	P 值
年龄（岁， $\overset{ˉ}{x}$ ± s ）		45.12±5.17	44.56±5.25	0.801	0.424
BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）		22.16±0.65	22.31±0.79	1.475	0.141
MELD评分（ $\overset{ˉ}{x}$ ± s ）		26.69±2.45	23.85±2.99	7.383	＜0.001
性别［例（%）］	男（n=267）	59（81.94）	208（82.21）	0.003	0.958
	女（n=58）	13（18.06）	45（17.79）
症状表现［例（%）］	腹水（n=124）	17（23.61）	107（42.29）	8.290	0.004
	腹膜炎（n=201）	55（76.39）	146（57.71）
合并症［例（%）］	肝硬化（n=137）	31（43.06）	106（41.9）	0.031	0.861
	糖尿病（n=43）	12（16.67）	31（12.25）	0.951	0.329
	高血压（n=33）	9（12.50）	24（9.49）	0.558	0.455
凝血功能（ $\overset{ˉ}{x}$ ± s ）	INR	2.72±0.35	1.99±0.23	20.928	＜0.001
	PLT（×10⁹/L）	111.83±11.59	110.69±12.34	0.701	0.484
	APTT（s）	55.21±6.34	43.69±3.75	19.379	＜0.001
肝功能（ $\overset{ˉ}{x}$ ± s ）	ALT（U/L）	988.81±69.54	525.37±31.77	80.657	＜0.001
	AST（U/L）	833.87±52.69	381.64±41.75	76.277	＜0.001
	TBIL（μmol/L）	377.81±62.54	359.63±34.71	3.208	0.001
疾病严重度分期［例（%）］	前期-早期（n=222）	30（41.67）	192（75.89）	30.323	＜0.001
	中期-晚期（n=103）	42（58.33）	61（24.11）

临床资料		发生组（n=72）	未发生组（n=253）	t/χ ² 值	P 值
年龄（岁， $\overset{ˉ}{x}$ ± s ）		45.12±5.17	44.56±5.25	0.801	0.424
BMI（kg/m²， $\overset{ˉ}{x}$ ± s ）		22.16±0.65	22.31±0.79	1.475	0.141
MELD评分（ $\overset{ˉ}{x}$ ± s ）		26.69±2.45	23.85±2.99	7.383	＜0.001
性别［例（%）］	男（n=267）	59（81.94）	208（82.21）	0.003	0.958
	女（n=58）	13（18.06）	45（17.79）
症状表现［例（%）］	腹水（n=124）	17（23.61）	107（42.29）	8.290	0.004
	腹膜炎（n=201）	55（76.39）	146（57.71）
合并症［例（%）］	肝硬化（n=137）	31（43.06）	106（41.9）	0.031	0.861
	糖尿病（n=43）	12（16.67）	31（12.25）	0.951	0.329
	高血压（n=33）	9（12.50）	24（9.49）	0.558	0.455
凝血功能（ $\overset{ˉ}{x}$ ± s ）	INR	2.72±0.35	1.99±0.23	20.928	＜0.001
	PLT（×10⁹/L）	111.83±11.59	110.69±12.34	0.701	0.484
	APTT（s）	55.21±6.34	43.69±3.75	19.379	＜0.001
肝功能（ $\overset{ˉ}{x}$ ± s ）	ALT（U/L）	988.81±69.54	525.37±31.77	80.657	＜0.001
	AST（U/L）	833.87±52.69	381.64±41.75	76.277	＜0.001
	TBIL（μmol/L）	377.81±62.54	359.63±34.71	3.208	0.001
疾病严重度分期［例（%）］	前期-早期（n=222）	30（41.67）	192（75.89）	30.323	＜0.001
	中期-晚期（n=103）	42（58.33）	61（24.11）

影响因素	β	SE（β）	Wald χ ² 值	P 值	OR	95% CI
MELD 评分≥25 分	2.231	0.445	25.135	＜0.001	9.309	3.892～22.269
发生腹膜炎	1.896	0.382	24.635	＜0.001	6.659	3.150～14.080
INR≥2.54	1.175	0.118	99.154	＜0.001	3.238	2.570～4.081
APTT≥48.10 s	1.656	0.273	36.796	＜0.001	5.238	3.068～8.945
ALT≥675.40 U/L	0.524	0.681	0.592	0.124	1.689	0.445～6.416
AST≥626.80 U/L	0.447	0.529	0.714	0.158	1.564	0.554～4.410
TBIL≥364.20 μmol/L	0.381	0.112	11.572	0.133	1.464	1.175～1.823
病情处于中期-晚期	3.175	0.738	18.509	＜0.001	23.927	5.632～101.644

组别	灵敏度	特异性	准确率	阳性预测值	阴性预测值
训练集	95.83	95.65	95.69	86.25	98.78
验证集	89.66	90.00	89.93	70.27	97.06

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