Discussion
bloodstream infection, critically ill, cirrhosis, liver cirrhosis, RDW, low arterial blood pressure
DECREASED IMMUNE FUNCTION, VASODILATION, BLOODSTREAM INFECTION, CRITICALLY ILL, INFLAMMATION, DISEASE, CIRRHOSIS, LIVER CIRRHOSIS, VASCULAR DILATION, SYNDROME, OXIDATIVE STRESS
This study is the first to use the MIMIC-III database to study the 90-day survival prediction of patients with liver cirrhosis and HE in the ICU. At present, there is still a lack of a good prognosis prediction model in patients with liver cirrhosis and HE. Although many current disease severity scores, such as MELD and SOFA scores, have specific predictive power for the prognosis of patients [This study focuses on vital signs, related laboratory indicators, disease severity scores, and the therapeutic measures of patients with liver cirrhosis and HE during hospitalization.In this study, advanced age was an independent risk factor for poor prognosis in patients with liver cirrhosis combined with HE. The older the age, the worse the patient’s prognosis. This may be associated with decreased immune function and liver metabolic function, and changes in the gut-brain axis in older people [The ICU physician pays close attention to the patient’s vital signs. The vital signs change is a significant indicator for physicians to directly judge the patient’s physical state and make the subsequent treatment decisions. Mean heart rate and mean arterial pressure(MAP) are the most common indicators of patient resuscitation that ICU physicians pay attention to. Mean heart rate and MAP are often used to reflect the patient’s cardiac function and blood volume. This study found that the higher the mean heart rate and the lower the MAP within 24 hours of admission to the ICU, the worse the prognosis of patients. The increased heart rate and decreased arterial pressure may reflect high dynamic circulation due to vascular dilation in the body’s viscera. Visceral vasodilation leads to hyperdynamic circulation syndrome, characterized by increased cardiac output and heart rate, decreased systemic vascular resistance, and low arterial blood pressure [Red blood cell distribution width (RDW), as a simple and readily available biological index, has been paid much attention. RDW has been shown to be strongly associated with all-cause mortality and risk of bloodstream infection in critically ill patients, and it may reflect the overall inflammation, oxidative stress, or insufficient arterial filling of the patients [At present, the development of prognostic models related to cirrhosis combined with HE rarely incorporates therapeutic measures as research factors. In this study, therapeutic measures during hospitalization, such as the use of albumin and PPI, etc., were included, and the results showed that albumin infusion and PPI use were associated with the prognosis of the patients. Albumin plays a very powerful role in the human body. It can expand blood volume, improve microcirculation, bind and transport a variety of substances, and have excellent antioxidant properties [