The Free Triiodothyronine, Gamma-Glutamyl Transpeptidase and Spontaneous Bacterial Peritonitis Index: A Novel Model for Predicting 1-Year Mortality in Patients with HBV-Related Hepatic Encephalopathy

Abstract

Lin Lin,1,2,* Ze-yu Huang,1,* Kai Liu,1,3 Xue-cheng Tong,1,3 Zhi-xin Zhang,4 Yuan Xue1,3 1Institute of Hepatology, The Third People’s Hospital of Changzhou, Changzhou, People’s Republic of China; 2Department of Pharmacy, The Third People’s Hospital of Changzhou, Changzhou Medical Center, Nanjing Medical University, Changzhou, People’s Republic of China; 3Department of Infectious Diseases, The Third People’s Hospital of Changzhou, Changzhou Medical Center, Nanjing Medical University, Changzhou, People’s Republic of China; 4Department of Pulmonary Diseases, The Third People’s Hospital of Changzhou, Changzhou Medical Center, Nanjing Medical University, Changzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yuan Xue; Zhi-xin Zhang, Email [email protected]; [email protected] and Aims: Hepatic encephalopathy (HE) is characterized by neuropsychiatric manifestations in patients with decompensated cirrhosis (DC) and/or liver failure. This study aimed to investigate the predictive value of thyroid hormone in patients with HE.Methods: Patients with DC and HE were enrolled, and multivariate logistic analysis was conducted to analyze the risk factors for 1-year mortality.Results: Among the 81 patients with HBV-related DC and HE, 9 (11.1%) died within 3 months, and 15 (18.5%) died within the first year. More patients with FT3 < 3.5pmol/L had ascites (33.3% vs 8.9%, P< 0.01) and higher model for end-stage liver disease (MELD) (Z=3.669, P< 0.01). Additionally, free triiodothyronine (FT3) levels were lower in the non-survivor group (P< 0.01). FT3 exhibited a negative correlation with international normalized ratio and MELD (both P< 0.05). Multivariate analysis revealed that FT3, gamma-glutamyl transpeptidase (GGT), and spontaneous bacterial peritonitis (SBP) were independent risk factors for 1-year mortality of HE. A new model incorporating FT3, GTT, and SBP demonstrated superiority to MELD based on the AUROC (0.9 and 0.752, P=0.04).Conclusion: Low FT3, but not thyroid-stimulating hormone and free tetraiodothyronine, was identified as an independent risk factor for 1-year mortality in patients with DC and HE. The newly proposed prognostic model, which includes FT3, GTT, and SBP, holds significant predictive value.Keywords: hepatic encephalopathy, free triiodothyronine, model for end-stage liver disease, gamma-glutamyl transpeptidase, mortality

Keywords

• hepatic encephalopathy
• free triiodothyronine
• model for end-stage liver disease
• gamma-glutamyl transpeptidase
• mortality