A network calculator based on the platelet index score effectively predicts the prognosis of patients with decompensated cirrhosis

Abstract

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

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.

References

[1] Zhang T, Ye B, Shen J. Prognostic value of albumin-related ratios in HBV-associated decompensated cirrhosis[J]. J Clin Lab Anal. 2022;36(4):e24338.
[2] 杨健,詹前美.凝血功能和血小板各项参数对重症肝硬化患者的检测价值[J].中国急救复苏与灾害医学杂志,2024,19(05):645-647+662.
[3] Li L, Yu J, Zhou Z. Association between platelet indices and non-alcoholic fatty liver disease: a systematic review and meta-analysis[J]. Rev Esp Enferm Dig, 2024,116(5):264-273.
[4] HOFER BS, BRUSILOVSKAYA K, SIMBRUNNER B, et al. Decreased platelet activation predicts hepatic decompensation and mortality in patients with cirrhosis[J]. Hepatology, 2023,Dec 27.
[5] Zhou J, Li X, Wang M, et al. Platelet-to-monocyte ratio as a novel promising agent for the prognosis of hepatitis B virus-associated decompensated cirrhosis[J]. Can J Gastroenterol Hepatol, 2023,2023:6646156.
[6] 赵芯,李晖,邓秀秀,等. 抗血小板药物与肝纤维化[J]. 实用医学杂志,2024,40(8):1083-1087.
[7] Han X, Xu P, Duan X, et al. High mean platelet volume-to-platelet count ratio as a diagnostic maker for increased risk of liver function damage in pediatric patients with infectious mononucleosis in China[J]. Exp Ther Med, 2019,18(6):4523-4527.
[8] Xianghong G, Guanping C, Fenghua Y, et al. Changes in platelet functional parameters and CD62 P expression in liver cirrhosis[J]. Afr Health Sci, 2013,13(4):1079-1083.
[9] Kang SY, Wang Y, Zhou LP, et al. New indicators in evaluation of hemolysis, elevated liver enzymes, and low platelet syndrome: a case-control study[J]. World J Clin Cases, 2021,9(6):1259-1270.
[10] Zhong ZH, Liang L, Fu TW, et al. Prognostic value of platelet distribution width to lymphocyte ratio in patients with hepatocellular carcinoma following hepatectomy[J]. BMC Cancer, 2023,23(1):1116.
[11] Kamimura K, Sakamaki A, Kamimura H, et al. Considerations of elderly factors to manage the complication of liver cirrhosis in elderly patients[J]. World J Gastroenterol, 2019,25(15):1817-1827.
[12] Antar SA, Ashour NA, Sharaky M, et al. Diabetes mellitus: classification, mediators, and complications; a gate to identify potential targets for the development of new effective treatments[J]. Biomed Pharmacother, 2023,168:115734.
[13] Nath P, Anand AC. Hepatogenous diabetes: a primer[J]. J Clin Exp Hepatol, 2021,11(5):603-615.
[14] Grvngreiff K, Gottstein T, Reinhold D, et al. Albumin substitution in decompensated liver cirrhosis: don't forget zinc[J]. Nutrients, 2021,13(11):4011.
[15] Han Z, He X, Peng S. Neutrophil count to albumin ratio as a prognostic indicator for HBV-associated decompensated cirrhosis[J]. J Clin Lab Anal, 2021,35(4):e23730.
[16] Ye B, Ding Q, He X, et al. High C-reactive protein-to-lymphocyte ratio is predictive of unfavorable prognosis in HBV-associated decompensated cirrhosis[J]. Lab Med, 2022,53(6):e149-e153.