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Objective To explore the factors influencing hospitalized new-onset overt hepatic encephalopathy (OHE) in hospitalized patients with hepatitis B-associated acute-on-chronic liver failure (HBV-ACLF), and to construct an individualized risk prediction model. Methods A total of 310 HBV-ACLF patients admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University from December 2016 to December 2020 were selected, and divided into non-hepatic encephalopathy group(n=236), hepatic encephalopathy group (n=74) according to whether OHE occurred after admission. The general data, laboratory test indicators, and model of end-stage liver disease (MELD) scores were compared between the two groups; univariate and multivariate logistic regressions were used to analyze the factors influencing the hospitalized new-onset OHE in HBV-ACLF patients after admission. A nomogram model was constructed with the influencing factors. The receiver operating characteristic (ROC)curve and the calibration curve was used to evaluate the discrimination and calibration of the model, and decision curve analysis(DCA) was used to evaluate the clinical validity of the model. Results Compared with the non-hepatic encephalopathy group, the baseline international normalized ratio [2.71(2.20, 3.44) vs. 1.98(1.70, 2.55)], serum alanine aminotransferase [987.50(450.50,1538.00) U/L vs. 561.00(191.00, 1090.50) U/L], blood aspartate aminotransferase [830.00(257.75, 1518.25) U/L vs. 381.00(153.50, 872.00) U/L], plasma Ammonia [71.75(57.75, 109.50) μmol/L vs. 57.00(41.80, 79.60) μmol/L], white blood cell count [7.93(6.43, 9.74)×109/L vs. 6.62(5.33, 8.16)×109/L], hemoglobin [136.50 (126.25, 151.50) g/L vs. 126.00(115.00,143.00) g/L], and the proportion of patients in intermediate and advanced stages (56.8% vs. 23.3%) of the hepatic encephalopathy group were higher, the difference was statistically significant; the alpha-fetoprotein level was lower [56.33(23.61, 139.03) ng/L vs. 88.25(31.32, 216.88) ng/L, P=0.033], the difference was statistically significant (P<0.001). The results of multivariate logistic regression analysis showed that baseline international normalized ratio (OR=2.56, 95%CI 1.61-4.30, P<0.001), age (OR=1.06, 95%CI 1.02-1.10, P=0.003), plasma ammonia (OR=1.02, 95%CI 1.01-1.03, P=0.005), blood white blood cell count (OR=1.24, 95%CI 1.07-1.43, P=0.003), hemoglobin (OR=1.03, 95%CI 1.00-1.05, P=0.026) were the independent influencing factors of hospitalized new-onset OHE in HBV-ACLF patients. The area under the ROC curve (AUC) of the nomogram model established in this study was 0.848(95%CI 0.798-0.897), and the MELD model was 0.723(95%CI 0.654-0.793). The maximum bias (Emax)=0.143 and the minimum bias (Eavg=0.041 between the nomogram model and the ideal model, the model has a good degree of discrimination,S:p=0.676. Through the calibration test, the model predicted value is consistent with the actual value. The performance was good, the decision curve showed that the threshold was in the range of 0.05 to 1.0, and the net benefit rate of the nomogram model was higher than that of the MELD model. Conclusions Age, international normalized ratio, white blood cell count, plasma ammonia, and hemoglobin are the factors influencing hospitalized new-onset OHE in HBV-ACLF patients. Nomogram constructed from five independent influencing factors can more accurately predict the risk of hospitalized new-onset OHE in this population, thus having a good clinical application value.
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| 科 Family | 属数 Number of genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) | 属 Genus | 种数 Number of species | 占总种数比例 Percentage of total species (%) |
|---|---|---|---|---|---|---|
| 鹅膏菌科Amanitaceae | 2 | 11 | 5.26 | 鹅膏菌属 Amanita | 10 | 4.78 |
| 小菇科 Mycenaceae | 2 | 12 | 5.74 | 丝盖伞属 Inocybe | 5 | 2.39 |
| 多孔菌科 Polyporaceae | 8 | 14 | 6.70 | 蜡蘑属 Laccaria | 5 | 2.39 |
| 红菇科 Russulaceae | 3 | 23 | 11.00 | 小皮伞属 Marasmius | 6 | 2.87 |
| 小菇属 Mycena | 11 | 5.26 | ||||
| 光柄菇属 Pluteus | 5 | 2.39 | ||||
| 红菇属 Russula | 17 | 8.13 | ||||
| 栓菌属 Trametes | 5 | 2.39 |
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