Portal hypertension and liver function injury are the main manifestations of advanced liver cirrhosis, while esophageal varices is one of the most serious complications of portal hypertension in liver cirrhosis. Most scholars believe that it is related to liver damage caused by bile acid deposition, immune factors, alcohol, viruses, and other long-term ongoing effects ( 1). It is caused by advanced liver disease with a complex clinical pathogenesis. Liver cirrhosis is a chronic liver disease characterized by pseudolobule formation, hepatocyte necrosis, regenerated nodules, and diffused fibrosis. The nomogram is easy to use, performs well, and can be used to guide clinical practice, but further external prospective validation is still required. DCA curves indicated that the nomogram had good value in clinical applications.Ĭonclusion: We have established the first prognostic nomogram for predicting the in-hospital death of LCEV patients. Improvements in NRI and IDI values suggested that our nomogram was superior to MELD-Na, CAGIB, and OASIS scoring system. High AUC values indicated the good discriminative ability of the nomogram, while the calibration curves and the Hosmer-Lemeshow test results demonstrated that the nomogram was well-calibrated. The nomogram was then constructed and validated. Results: Nine independent prognostic factors were identified by using LASSO and stepwise regressions: age, Elixhauser score, anion gap, sodium, albumin, bilirubin, international normalized ratio, vasopressor use, and bleeding. Multiple indicators were used to validate the nomogram, including the area under the receiver operating characteristic curve (AUC), calibration curve, Hosmer-Lemeshow test, integrated discrimination improvement (IDI), net reclassification index (NRI), and decision curve analysis (DCA). We then constructed a nomogram to predict the in-hospital death of LCEV patients. The independent prognostic factors for LCEV patients were determined using the least absolute shrinkage and selection operator (LASSO) method and forward stepwise logistic regression. Training cohort was used for establishing the model, validation and MIMIC-IV cohorts were used for validation. The patients from MIMIC-III were randomly divided into training and validation cohorts. Methods: Data on LCEV patients were extracted from the Medical Information Mart for Intensive Care III and IV (MIMIC-III and MIMIC-IV) database. We aimed to establish and validate a nomogram for predicting in-hospital death in LCEV patients. Despite the development of various treatments, the prognosis for liver cirrhosis with esophageal varices (LCEV) remains poor. Esophageal varices is a common and serious complication of liver cirrhosis during decompensation. Introduction: Liver cirrhosis is caused by the development of various acute and chronic liver diseases. 5School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, China.4Department of Public Health, University of California, Irvine, Irvine, CA, United States.3Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China.2School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China.1Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.Fengshuo Xu 1,2 †, Luming Zhang 3 †, Zichen Wang 4, Didi Han 1,2, Chengzhuo Li 1,2, Shuai Zheng 1,5, Haiyan Yin 3 * and Jun Lyu 1,2 *
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