Increased INR Values Predict Accelerating Deterioration and High Short-Term Mortality Among Patients Hospitalized With Cirrhosis or Advanced Fibrosis
Background and Objective: An increase in the international normalized ratio (INR) is associated with increased mortality in patients with cirrhosis and other chronic liver diseases, while little is known about the quantitative relationship. This study aimed to investigate the quantitative relationsh...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:deaf7f5e2a724ebda1ef9e64c4c418bc2021-11-18T07:17:19ZIncreased INR Values Predict Accelerating Deterioration and High Short-Term Mortality Among Patients Hospitalized With Cirrhosis or Advanced Fibrosis2296-858X10.3389/fmed.2021.762291https://doaj.org/article/deaf7f5e2a724ebda1ef9e64c4c418bc2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.762291/fullhttps://doaj.org/toc/2296-858XBackground and Objective: An increase in the international normalized ratio (INR) is associated with increased mortality in patients with cirrhosis and other chronic liver diseases, while little is known about the quantitative relationship. This study aimed to investigate the quantitative relationship between the INR and short-term prognosis among patients hospitalized with cirrhosis or advanced fibrosis and to evaluate the role of the INR as a risk factor for short-term liver transplant (LT)-free mortality in these patients.Patients and Methods: This study prospectively analyzed multicenter cohorts established by the Chinese Acute-on-Chronic Liver Failure (CATCH-LIFE) study. Cox regression was used to describe the relationship between the INR and independent risk factors for short-term LT-free mortality. Forest plots were used in the subgroup analysis. Generalized additive models (GAMs) and splines were used to illustrate the quantitative curve relationship between the INR and the outcome and inflection point on the curve.Results: A total of 2,567 patients with cirrhosis and 924 patients with advanced fibrosis were included in the study. The 90-day LT-free mortality of patients with cirrhosis and advanced fibrosis was 16.7% (428/2,567) and 7.5% (69/924), respectively. In the multivariable Cox regression analysis, the increase in the INR was independently associated with the risk of 90-day LT-free mortality both in patients with cirrhosis (HR, 1.06; 95% CI, 1.04–1.07, p < 0.001) and in patients with advanced fibrosis (HR, 1.09; 95% CI, 1.06–1.12, p < 0.001). An INR of 1.6/1.7 was found to be the starting point of coagulation dysfunction with a rapid increase in mortality in patients with cirrhosis or in patients with advanced fibrosis, respectively. A 28-day LT-free mortality of 15% was associated with an INR value of 2.1 in both cirrhosis and advanced fibrosis patients.Conclusions: This study was the first to quantitatively describe the relationship between the INR and short-term LT-free mortality in patients with cirrhosis or advanced fibrosis. The starting points of INR indicating the rapid increase in mortality and the unified cutoff value of coagulation failure in cirrhosis and advanced fibrosis, will help clinicians accurately recognize early disease deterioration.Ying WangYing WangFuchen DongFuchen DongShuning SunShuning SunXianbo WangXianbo WangXin ZhengXin ZhengYan HuangYan HuangBeiling LiBeiling LiYanhang GaoYanhang GaoZhiping QianZhiping QianFeng LiuFeng LiuXiaobo LuXiaobo LuJunping LiuJunping LiuHaotang RenHaotang RenYubao ZhengYubao ZhengHuadong YanHuadong YanGuohong DengGuohong DengLiang QiaoLiang QiaoYan ZhangYan ZhangWenyi GuWenyi GuXiaomei XiangXiaomei XiangYi ZhouYi ZhouBaoyan XuBaoyan XuYixin HouYixin HouQun ZhangQun ZhangYan XiongYan XiongCongcong ZouCongcong ZouJun ChenJun ChenZebing HuangZebing HuangXiuhua JiangXiuhua JiangTingting QiTingting QiSen LuoSen LuoYuanyuan ChenYuanyuan ChenNa GaoNa GaoChunyan LiuChunyan LiuWei YuanWei YuanXue MeiXue MeiJing LiJing LiTao LiTao LiRongjiong ZhengRongjiong ZhengXinyi ZhouXinyi ZhouWeituo ZhangWeituo ZhangHai LiHai LiZhongji MengZhongji MengFrontiers Media S.A.articleacute on chronic liver failure (ACLF)cirrhosisadvanced fibrosisinternational normalized ratio (INR)short-term prognosisMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021) |
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| collection |
DOAJ |
| language |
EN |
| topic |
acute on chronic liver failure (ACLF) cirrhosis advanced fibrosis international normalized ratio (INR) short-term prognosis Medicine (General) R5-920 |
| spellingShingle |
acute on chronic liver failure (ACLF) cirrhosis advanced fibrosis international normalized ratio (INR) short-term prognosis Medicine (General) R5-920 Ying Wang Ying Wang Fuchen Dong Fuchen Dong Shuning Sun Shuning Sun Xianbo Wang Xianbo Wang Xin Zheng Xin Zheng Yan Huang Yan Huang Beiling Li Beiling Li Yanhang Gao Yanhang Gao Zhiping Qian Zhiping Qian Feng Liu Feng Liu Xiaobo Lu Xiaobo Lu Junping Liu Junping Liu Haotang Ren Haotang Ren Yubao Zheng Yubao Zheng Huadong Yan Huadong Yan Guohong Deng Guohong Deng Liang Qiao Liang Qiao Yan Zhang Yan Zhang Wenyi Gu Wenyi Gu Xiaomei Xiang Xiaomei Xiang Yi Zhou Yi Zhou Baoyan Xu Baoyan Xu Yixin Hou Yixin Hou Qun Zhang Qun Zhang Yan Xiong Yan Xiong Congcong Zou Congcong Zou Jun Chen Jun Chen Zebing Huang Zebing Huang Xiuhua Jiang Xiuhua Jiang Tingting Qi Tingting Qi Sen Luo Sen Luo Yuanyuan Chen Yuanyuan Chen Na Gao Na Gao Chunyan Liu Chunyan Liu Wei Yuan Wei Yuan Xue Mei Xue Mei Jing Li Jing Li Tao Li Tao Li Rongjiong Zheng Rongjiong Zheng Xinyi Zhou Xinyi Zhou Weituo Zhang Weituo Zhang Hai Li Hai Li Zhongji Meng Zhongji Meng Increased INR Values Predict Accelerating Deterioration and High Short-Term Mortality Among Patients Hospitalized With Cirrhosis or Advanced Fibrosis |
| description |
Background and Objective: An increase in the international normalized ratio (INR) is associated with increased mortality in patients with cirrhosis and other chronic liver diseases, while little is known about the quantitative relationship. This study aimed to investigate the quantitative relationship between the INR and short-term prognosis among patients hospitalized with cirrhosis or advanced fibrosis and to evaluate the role of the INR as a risk factor for short-term liver transplant (LT)-free mortality in these patients.Patients and Methods: This study prospectively analyzed multicenter cohorts established by the Chinese Acute-on-Chronic Liver Failure (CATCH-LIFE) study. Cox regression was used to describe the relationship between the INR and independent risk factors for short-term LT-free mortality. Forest plots were used in the subgroup analysis. Generalized additive models (GAMs) and splines were used to illustrate the quantitative curve relationship between the INR and the outcome and inflection point on the curve.Results: A total of 2,567 patients with cirrhosis and 924 patients with advanced fibrosis were included in the study. The 90-day LT-free mortality of patients with cirrhosis and advanced fibrosis was 16.7% (428/2,567) and 7.5% (69/924), respectively. In the multivariable Cox regression analysis, the increase in the INR was independently associated with the risk of 90-day LT-free mortality both in patients with cirrhosis (HR, 1.06; 95% CI, 1.04–1.07, p < 0.001) and in patients with advanced fibrosis (HR, 1.09; 95% CI, 1.06–1.12, p < 0.001). An INR of 1.6/1.7 was found to be the starting point of coagulation dysfunction with a rapid increase in mortality in patients with cirrhosis or in patients with advanced fibrosis, respectively. A 28-day LT-free mortality of 15% was associated with an INR value of 2.1 in both cirrhosis and advanced fibrosis patients.Conclusions: This study was the first to quantitatively describe the relationship between the INR and short-term LT-free mortality in patients with cirrhosis or advanced fibrosis. The starting points of INR indicating the rapid increase in mortality and the unified cutoff value of coagulation failure in cirrhosis and advanced fibrosis, will help clinicians accurately recognize early disease deterioration. |
| format |
article |
| author |
Ying Wang Ying Wang Fuchen Dong Fuchen Dong Shuning Sun Shuning Sun Xianbo Wang Xianbo Wang Xin Zheng Xin Zheng Yan Huang Yan Huang Beiling Li Beiling Li Yanhang Gao Yanhang Gao Zhiping Qian Zhiping Qian Feng Liu Feng Liu Xiaobo Lu Xiaobo Lu Junping Liu Junping Liu Haotang Ren Haotang Ren Yubao Zheng Yubao Zheng Huadong Yan Huadong Yan Guohong Deng Guohong Deng Liang Qiao Liang Qiao Yan Zhang Yan Zhang Wenyi Gu Wenyi Gu Xiaomei Xiang Xiaomei Xiang Yi Zhou Yi Zhou Baoyan Xu Baoyan Xu Yixin Hou Yixin Hou Qun Zhang Qun Zhang Yan Xiong Yan Xiong Congcong Zou Congcong Zou Jun Chen Jun Chen Zebing Huang Zebing Huang Xiuhua Jiang Xiuhua Jiang Tingting Qi Tingting Qi Sen Luo Sen Luo Yuanyuan Chen Yuanyuan Chen Na Gao Na Gao Chunyan Liu Chunyan Liu Wei Yuan Wei Yuan Xue Mei Xue Mei Jing Li Jing Li Tao Li Tao Li Rongjiong Zheng Rongjiong Zheng Xinyi Zhou Xinyi Zhou Weituo Zhang Weituo Zhang Hai Li Hai Li Zhongji Meng Zhongji Meng |
| author_facet |
Ying Wang Ying Wang Fuchen Dong Fuchen Dong Shuning Sun Shuning Sun Xianbo Wang Xianbo Wang Xin Zheng Xin Zheng Yan Huang Yan Huang Beiling Li Beiling Li Yanhang Gao Yanhang Gao Zhiping Qian Zhiping Qian Feng Liu Feng Liu Xiaobo Lu Xiaobo Lu Junping Liu Junping Liu Haotang Ren Haotang Ren Yubao Zheng Yubao Zheng Huadong Yan Huadong Yan Guohong Deng Guohong Deng Liang Qiao Liang Qiao Yan Zhang Yan Zhang Wenyi Gu Wenyi Gu Xiaomei Xiang Xiaomei Xiang Yi Zhou Yi Zhou Baoyan Xu Baoyan Xu Yixin Hou Yixin Hou Qun Zhang Qun Zhang Yan Xiong Yan Xiong Congcong Zou Congcong Zou Jun Chen Jun Chen Zebing Huang Zebing Huang Xiuhua Jiang Xiuhua Jiang Tingting Qi Tingting Qi Sen Luo Sen Luo Yuanyuan Chen Yuanyuan Chen Na Gao Na Gao Chunyan Liu Chunyan Liu Wei Yuan Wei Yuan Xue Mei Xue Mei Jing Li Jing Li Tao Li Tao Li Rongjiong Zheng Rongjiong Zheng Xinyi Zhou Xinyi Zhou Weituo Zhang Weituo Zhang Hai Li Hai Li Zhongji Meng Zhongji Meng |
| author_sort |
Ying Wang |
| title |
Increased INR Values Predict Accelerating Deterioration and High Short-Term Mortality Among Patients Hospitalized With Cirrhosis or Advanced Fibrosis |
| title_short |
Increased INR Values Predict Accelerating Deterioration and High Short-Term Mortality Among Patients Hospitalized With Cirrhosis or Advanced Fibrosis |
| title_full |
Increased INR Values Predict Accelerating Deterioration and High Short-Term Mortality Among Patients Hospitalized With Cirrhosis or Advanced Fibrosis |
| title_fullStr |
Increased INR Values Predict Accelerating Deterioration and High Short-Term Mortality Among Patients Hospitalized With Cirrhosis or Advanced Fibrosis |
| title_full_unstemmed |
Increased INR Values Predict Accelerating Deterioration and High Short-Term Mortality Among Patients Hospitalized With Cirrhosis or Advanced Fibrosis |
| title_sort |
increased inr values predict accelerating deterioration and high short-term mortality among patients hospitalized with cirrhosis or advanced fibrosis |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/deaf7f5e2a724ebda1ef9e64c4c418bc |
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