Value of indicators including serum neuron-specific enolase in assessing prognosis of patients with cirrhosis complicated by overt hepatic encephalopathy
Objective To investigate the predictive value of serum neuron-specific enolase(NSE),prognostic nutritional index(PNI)score,hepatic encephalopathy(HE)grading,and the integrated model for end-stage liver disease(iMELD)score in assessing the short-term(90-day)prognosis of patients with cirrhosis complicated by overt hepatic encephalopathy(HE).Methods A retrospective analysis was conducted on clinical data from 470 patients with cirrhosis and overt HE,and they were divided into survival group(n=359)and mortality group(n=111)based on their survival status 90 days after admission.The PNI and iMELD scores were calculated using patient de-mographics,blood routine tests,coagulation function,liver and renal function electrolyte levels,and serum NSE levels within 24 hours of admission,along with HE grading.Receiver operating character-istic(ROC)curves,multivariate Logistic regression analysis,and Kaplan-Meier survival curves were employed to evaluate influencing factors of short-term prognosis of patients with cirrhosis and overt HE.Results The mortality group exhibited significantly higher serum NSE levels,HE grades,and iMELD scores,while demonstrated lower PNI score compared to the survival group(P＜0.05).Mult-ivariate Logistic regression analysis identified serum NSE,PNI score,HE grade,and iMELD score as independent predictors of short-term prognosis.The areas under the curve(AUCs)for serum NSE,PNI score,HE grade,and iMELD score in predicting short-term prognosis were 0.727,0.717,0.721,and 0.728,respectively,with cut-off values of 12.23 ng/mL,34.05 ng/mL,and 39.26 points for serum NSE,PNI score,and iMELD score.A combined prediction model of four factors demonstrated the highest predictive performance,with an AUC of 0.919 and a cut-off value of 0.23.Kaplan-Meier survival analysis revealed that patients with combined score of serum NSE,PNI score,HE grade,and iMELD cut-off value＜0.23 had a significantly higher 90-day survival rate compared to those with cut-off value≥0.23(Log-Rank=265.567,P＜0.001).Conclusion Serum NSE,PNI score,HE grade,and iMELD score exhibit good value in predicting the short-term prognosis of pa-tients with cirrhosis and overt HE,with an even higher predictive value when used in combination.
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