基于血小板指数评分的网络计算器预测肝硬化失代偿患者预后

摘要/Abstract

摘要： 目的基于血小板指数评分(PIS)构建网络计算器预测肝硬化失代偿患者6个月内死亡风险。方法选取上海市公共卫生临床中心2021年1月至2023年1月治疗的肝硬化失代偿患者182例。受试者工作特征(ROC)曲线构建PIS。采用单因素和多因素Cox回归模型分析肝硬化失代偿病死风险的独立预后因素。使用rms、foreign、readxl、Hmisc和rmda等R包构建和评估列线图预测准确性。使用DynNom包开发肝硬化失代偿患者病死风险网络计算器。根据ROC曲线分析评估年龄、糖尿病、MELD评分、Alb、NLR和PIS的最佳截断值分为高风险组和低风险组,绘制肝硬化失代偿患者的生存曲线并构建肝硬化失代偿患者28 d、3个月和6个月病死风险的列线图。结果 182例患者中,6个月病死率为36.8%。PIS预测患者病死风险的曲线下面积(AUC)为0.837(95%CI:0.776~0.888)。多因素Cox风险回归分析结果显示,年龄、糖尿病比例、MELD评分、Alb、NLR和PIS为肝硬化失代偿患者6个月内死的独立预后因素(P<0.05)。校正曲线显示列线图预测28 d、3个月和6个月病死风险的AUC分别为0.852、0.935和0.863,表明该列线图具有优异的预测效果。时间-决策曲线分析显示该列线图在28 d、3个月和6个月时间点均能提供临床净收益。网络计算器操作界面见(https://nomogram1203.shinyapps.io/Dynamic-sui/)。结论基于PIS开发的网络计算器能有效预测肝硬化失代偿患者6个月内病死风险。

关键词: 肝硬化, 失代偿, 血小板指数, 预后, 网络计算器

Abstract: Objective A network calculator based on platelet index score (PIS) was constructed to predict the death risk within 6 months in patients with decompensated liver cirrhosis. Methods One hundred and eighty-two patients with decompensated cirrhosis treated from January 2021 to January 2023 were selected. PIS was constructed based on the subjects' working characteristics (ROC) curves. The independent prognostic factors for the risk of death from decompensated cirrhosis were analyzed using univariate and multivariate Cox regression models. And R packages such as rms, foreign, readxl, Hmisc, and rmda were used to construct and evaluate nomogram predictive accuracy. The DynNom package was used to develop a network calculator for the risk of disease and death in patients with decompensated cirrhosis. Results The 6-month mortality rate was 36.8% in 182 patients. The area under the curve (AUC) for PIS to predict the death risk of the patients was 0.837 (95% CI=0.776~0.888). The results of multifactorial Cox risk regression analysis showed that age, proportion of diabetes, MELD score, Alb, NLR and PIS were independent prognostic factors for the risk of disease and death within 6 months in patients with decompensated cirrhosis (P<0.05). The best cut-off values for age, diabetes, MELD score, Alb, NLR and PIS were classified into high- and low-risk groups based on ROC curve analysis to assess the survival curves of patients with decompensated cirrhosis and to construct nomogram of the risk of disease and death at 28 days, 3 months and 6 months in patients with decompensated cirrhosis. The calibration curves showed that the AUC values of the nomogram for predicting the death risk at 28 days, 3 months and 6 months were 0.852 (0.804~0.942), 0.935 (0.879~0.985) and 0.863 (0.812~0.953), respectively, which demonstrated that the nomogram had excellent predictive efficacy. Time-Decision Curve Analysis (DCA) showed that the nomogram provided clinically significant net benefits at the 28-day, 3-month, and 6-month time points. The network calculator interface is available at website (https://nomogram1203.shinyapps.io/Dynamic-sui/). Conclusion A network calculator developed based on PIS effectively predicts the risk of death within 6 months in patients with decompensated cirrhosis.

Key words: Cirrhosis, Decompensation, Platelet index score, Prognosis, Network calculator

张明星, 张雯琼, 施理敏, 蔡思齐. 基于血小板指数评分的网络计算器预测肝硬化失代偿患者预后[J]. 肝脏, 2025, 30(2): 187-192.

ZHANG Ming-xing, ZHUANG Wen-qiong, SHI Li-min, CAI Si-qi. A network calculator based on the platelet index score effectively predicts the prognosis of patients with decompensated cirrhosis[J]. Chinese Hepatolgy, 2025, 30(2): 187-192.

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