A Novel Scoring System for Assessing In-Hospital Mortality Risk in Patients With Liver Cirrhosis

Abstract

Background Mortality among patients with liver cirrhosis has recently increased in Indonesia. However, predicting the prognosis of patients hospitalized with liver cirrhosis remains a clinical challenge due to its variability and dependence on multiple factors. A simple and accurate method is required to identify high-risk patients. This study aims to build a predictive scoring system of in-hospital mortality in patients hospitalized with liver cirrhosis for clinical application. Methods A retrospective cohort study was done to collect data on patients with liver cirrhosis from November 2021 to January 2022. The study involved 110 patients hospitalized with liver cirrhosis. A multivariate regression analysis was performed to identify factors predicting in-hospital mortality. Each variable's score was determined by applying the (B/SE)/lowest B/SE formula. The overall probability was calculated using the equation 1/1+exp(-y). Analysis of area under the curve (AUC) was conducted to evaluate the sensitivity and specificity of the scoring system. Results A total of 52 patients (47.3%) died during hospitalization. The median age of the patient was 54.5 (30-82). A final model involving the presence of hepatic encephalopathy (HE) (p = 0.001), ascites (p = 0.025), diabetes mellitus type II (p = 0.003), acute kidney injury (p = 0.017), alanine transaminase (ALT) ≥ 68 (p = 0.001), creatinine level ≥ 1.25 (p = 0.011), and abnormal international normalized ratio (INR) (p = 0.047). The “ADRECIA” score was developed, consisting of ascites, type II diabetes mellitus, renal injury, hepatic encephalopathy, creatinine serum, INR, and ALT. The presence of HE and ALT ≥68 was scored as two, and the rest variables were scored as one. The best-discriminating value was at a cut-off point ≥ 2.5, with a sensitivity of 90.4%, and a specificity of 74.1%, and an AUC of 0.913 (95%CI: 0.862-0.964). The scoring system was categorized as low risk (score of zero to three) with a 1.4-43.6% probability of death and high risk (score of 4-9) with 74.7-99.9% probability of death. Conclusion This scoring system provides good accuracy in predicting in-hospital mortality in patients with liver cirrhosis. Therefore, treatment can be modified according to the score to reduce mortality rates.