development and validation of a prognostic nomogram based on fibrosis-4 index to predict 3-month mortality in patients with hepatic encephalopathy

Background: hepatic encephalopathy is a severe neuropsychiatric complication of decompensated cirrhosis associated with high short-term mortality. objectives: this study aimed to evaluate the predictive value of non-invasive scoring systems and develop a prognostic nomogram to identify the risk of 3-month mortality in patients with hepatic encephalopathy. methods: retrospective data from 251 patients with decompensated cirrhosis and hepatic encephalopathy were collected. clinical data and non-invasive scoring systems were compared between survivors and non-survivors using univariate and multivariate logistic regression analyses. a prognostic model was developed and validated using bootstrap resampling procedures. results: among the 251 patients, 40 (15.9%) died within three months. the non-survivor group had a higher incidence of complications and higher non-invasive scores (all p < 0.01). multivariate analysis revealed that hepatorenal syndrome, spontaneous bacterial peritonitis, upper gastrointestinal bleeding, and fibrosis-4 index were independent risk factors. a new model incorporating the fibrosis-4 index and complications was developed, and discrimination was assessed using a bootstrap-corrected c statistic of 0.831. the area under the receiver operating characteristic curve of the new model (0.840, 95% confidence interval: 0.789 - 0.883) was significantly higher than that of the non-invasive scoring systems (all p < 0.05). the calibration plot and hosmer-lemeshow test (p = 0.771) showed good calibration accuracy. kaplan-meier survival analysis showed that the cumulative survival rate in the high-risk group was significantly lower (p < 0.01). conclusions: the prognostic nomogram consisting of the fibrosis-4 index and complications can effectively predict the risk of 3-month mortality in patients with hepatic encephalopathy.