Discussion
AKI, death, SIRS, APSIII
DECOMPENSATED CIRRHOSIS, LIVER CIRRHOSIS, COMPLICATION, SYSTEMIC INFLAMMATORY RESPONSE SYNDROME, CHRONIC LIVER DISEASE
Liver cirrhosis results from the development of various acute and chronic liver diseases, and HE is a common critical complication of decompensated cirrhosis. This retrospective study analyzed a relatively large population of MIMIC-IV, and found 8 variables were independent predictors of 28-day death. Notably, in this study, all indicators were obtained within the first 24 h of ICU admission, providing a short window for identifying severe patients with HE. Additionally, among the four ML models that were validated, NNET was the best model, with good discriminative (AUC = 0.837) and calibration ability simultaneously. Our model could potentially be useful to clinicians in their decision-making when it comes to the selection of therapeutic strategies. Features obtained in the final model included APSIII, SOFA, INR, TBIL, albumin, BUN, AKI and mechanical ventilation, which is consistent with the findings of other published studies.In a recent research, researchers also identified SOFA and systemic inflammatory response syndrome (SIRS) as factors associated with 30-day mortality in patients with HE [There were several strengths in this study. First, multiple ML algorithms were used to build a predictive model. Third, 8 variables selected for the final model are readily available in clinical practice, enabling the model to be implemented easily in the real world.This study had several limitations. First, because the model was based on MIMIC-IV, which is a single-center database, it still needs to be externally validated in other datasets. Secondly, all the variables were first obtained after an ICU admission, without considering that indicators were dynamically changing. Thirdly, originated from a retrospective cohort, the model needs further prospective validation before being considered for clinical application. Lastly, the majority of the patients included in this study were White, therefore, these findings may not be extrapolated to other populations, such as Asians.