Diagnostic and prognostic value of serum hepcidin concentration in patients with acute spontaneous supratentorial intracerebral hemorrhage

The aim of the study was to evaluate the diagnostic and prognostic value of serum hepcidin concentration in patients with acute spontaneous supratentorial intracerebral hemorrhage (SSICH). Materials and methods. Prospective cohort study of 88 patients with acute SSICH receiving the conservative therapy was conducted. Level of neurological deficit was evaluated using the Full Outline of UnResponsiveness Scale, the Glasgow Coma Scale and the National Institute of Health Stroke Scale. Computed tomography was performed to detect an intracerebral hemorrhage volume (ICHV), secondary intraventricular hemorrhage volume (SIVHV) and total volume of intracranial hemorrhage (TVICH). Laboratory blood samples were taken within 24 hours of hospitalization. Hepcidin levels, serum iron concentrations and total iron-binding capacity were determined, followed by calculations of transferrin saturation coefficient. Early neurological deterioration (END) and unfavorable variants of the acute period of SSICH (lethal outcome, modified Rankin score 4-5 on the 21st day of the disease) were considered as endpoints. Statistical processing of the obtained results included a correlation analysis, logistic regression analysis and ROC-analysis. Results. It was identified, that serum hepcidin level in the patients with SSICH was correlated with ICHV (R = 0.44, P ˂ 0.01), SIVHV (R = 0.45, P ˂ 0.01) and TVICH (R = 0.57, P ˂ 0.01). Hepcidin serum concentrations in the patients with ICHV >30 ml exceeded the value of those in cases of ICHV ≤30 ml by 69.0 % (P ˂ 0.0001). Serum levels of hepcidin were significantly higher in the patients with an unfavorable course and outcome of the disease in the acute period on the 1st day of admission (P ˂ 0.0001). Informative multipredictor models were developed via multiple logistic regression analysis, which include hepcidin values coupled with clinical and neurovisualization findings and are predictive of lethal and unfavorable acute period functional outcomes (AUC = 0,93, P ˂ 0.0001). Conclusions. The level of serum hepcidin in patients with acute SSICH is associated with the severity of cerebral lesions. The integration of serum hepcidin concentration with clinical and neuroimaging findings in the structure of multipredictor logistic regression models allows to determine the vital and functional prognosis of the acute period of SSICH with an accuracy of >85 %

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Prognostic value of serum S100B concentration in patients with acute spontaneous supratentorial intracerebral hemorrhage

Pathologia ◽

10.14739/2310-1237.2021.1.228850 ◽

2021 ◽

Vol 18 (1) ◽

pp. 19-25

Author(s):

О. A. Koziolkin ◽

A. A. Kuznietsov

Keyword(s):

Logistic Regression ◽

Intracerebral Hemorrhage ◽

Prognostic Value ◽

Conservative Therapy ◽

S100b Protein ◽

Short Term ◽

Serum S100b ◽

Acute Period ◽

Protein Levels ◽

Hemorrhage Volume

Aim of the work – to evaluate the informativeness of serum protein S100B levels in detection of short-term prognosis in patients with acute period of spontaneous supratentorial intracerebral hemorrhage (SSICH) on the background of concervative therapy. Materials and methods. Prospective cohort study of 90 patients with acute SSICH on the background of conservative therapy was done. Level of neurological deficit was evaluated using Full Outline of Unresponsiveness Scale, Glasgow Coma Scale and National Institute of Health Stroke Scale. Computed tomography was done to detect the intracerebral hemorrhage volume (ICHV), secondary intraventricular hemorrhage volume (SIVHV) and total volume of intracranial hemorrhage (TVICH). Laboratory blood samples were taken within 24 hours of hospitalization. Levels of S100B protein in serum were measured using immunoassay analysis. Unfavorable variants of course (early neurological deterioration (END) during 48 hours from hospitalization) and disease acute period outcome of ICH (modified Rankin score 4–6 on the 21st day of the disease) were considered as endpoints. Statistical processing of the obtained results included correlation analysis, logistic regression analysis and ROC-analysis. Results. Neurological deterioration during 48 hours after hospitalization was detected in 18 (20.0 %) patients, unfavorable SSICH acute period outcome was revealed in 49 (54.4 %) patients. It was detected that serum S100B protein correlates with ICHV (R = 0.34, P ˂ 0.01), SIVHV (R = 0.39, P ˂ 0.01) and TVICH (R = 0.45, P ˂ 0.01). Thus, the patients with unfavorable SSICH acute period course and outcome are characterized with the higher S100B protein levels (P ˂ 0.0001). High sensitive multipredicive logistic regression model that integrates prognostic value of serum of S100B protein concentration with informativeness of clinical, neurological parameters (National Institute of Health Stroke Scale score, SIVHV) was elaborated. It helps to detect the individual risk of unfavorable acute SSICH period outcome on the ground of conservative therapy with the accuracy 90.0 % (AUC ± SE (95 % CІ) = 0.95 ± 0.02 (0.89–0.99), P ˂ 0.0001). Conclusions. Serum S100B protein levels in patients with SSICH on the 1st day after hospitalization is the informative additional parameter in verification of short-term prognosis on the background of conservative therapy.

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Prognostic value of the neutrophil-to-lymphocyte ratio in acute organophosphorus pesticide poisoning

Open Life Sciences ◽

10.1515/biol-2021-0069 ◽

2021 ◽

Vol 16 (1) ◽

pp. 703-710

Author(s):

Yuhang Mu ◽

Boqi Hu ◽

Nan Gao ◽

Li Pang

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Hospital Mortality ◽

Logistic Regression Analysis ◽

Poor Prognosis ◽

Prognostic Value ◽

Organophosphorus Pesticide ◽

Neutrophil To Lymphocyte Ratio ◽

Pesticide Poisoning ◽

Lymphocyte Ratio

Abstract This study investigates the ability of blood neutrophil-to-lymphocyte ratio (NLR) to predict acute organophosphorus pesticide poisoning (AOPP). Clinical data of 385 patients with AOPP were obtained within 24 h of admission, and NLR values were calculated based on neutrophil and lymphocyte counts. The patients were divided into two groups – good and poor – based on prognosis. Poor prognosis included in-hospital death and severe poisoning. The factors affecting prognosis were analyzed by logistic regression analysis, and the prognostic value of NLR was evaluated using the area under the receiver operating characteristic curve (AUC). Univariate logistic regression analysis showed that NLR levels, serum cholinesterase, and creatinine levels were good predictors of AOPP. Multivariate logistic regression analysis showed that high NLR was an independent risk factor for severe poisoning (adjusted odds ratio [AOR], 1.13; 95% CI, 1.10–1.17; p < 0.05) and in-hospital mortality (AOR, 1.07; 95% CI, 1.03–1.11; p < 0.05). NLR values >13 and >17 had a moderate ability to predict severe poisoning and in-hospital mortality, respectively (AUC of 0.782 [95% CI, 0.74–0.824] and 0.714 [95% CI, 0.626–0.803], respectively). Our results show that high NLR at admission is an independent indicator of poor prognosis in AOPP and can be used to optimize treatment and manage patients.

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DIAGNOSTIC AND PROGNOSTIC VALUE OF IRON METABOLISM PARAMETERS IN PATIENTS WITH SPONTANEOUS SUPRATENTORIAL INTRACEREBRAL HAEMORRHAGE IN ACUTE PERIOD

Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії ◽

10.31718/2077-1096.21.1.35 ◽

2021 ◽

Vol 21 (1) ◽

pp. 35-44

Author(s):

A.A. Kuznietsov

Keyword(s):

Iron Metabolism ◽

Intracerebral Haemorrhage ◽

Prognostic Value ◽

Binding Capacity ◽

Transferrin Saturation ◽

Iron Binding ◽

Acute Period ◽

Serum Hepcidin ◽

Iron Binding Capacity ◽

Diagnostic And Prognostic Value

The aim of the study is to investigate the diagnostic and prognostic value of integrated assessment of iron metabolism parameters in patients with spontaneous supratentorial intracerebral haemorrhage in acute period. Materials and methods. This prospective cohort study included 88 patients with spontaneous supratentorial intracerebral haemorrhage during the course of conservative treatment. Diagnosis was made based on the findings of clinical and neuro-imaging investigations. On the 1st day of the hospital admission fasting blood samples were taken. Levels of ferritin, hepcidin, iron, total iron binding capacity, unsaturated iron binding capacity and transferrin saturation were detected. Early neurological deterioration and unfavourable outcome of acute period of spontaneous supratentorial intracerebral haemorrhage as grading 4-6 scores by modified Rankin scale on the 21st day of the disease were chosen as clinical endpoints. Lethal outcome and unfavourable functional outcome were also recorded. Results. Three profile types of evaluated iron metabolism parameters were identified based on the cluster analysis in the patients with intracerebral haemorrhage. It has been found out the profile types with initial higher levels of serum hepcidin and ferritin in blood together with lower serum iron concentration (type II and particularly type III) are associated with more severe cerebral structures damage and increased risk of early clinical deterioration (relative risk (95% confidence interval) = 6,01 (1,54–24,86), р=0,0120) and unfavourable functional outcome of the disease (relative risk (95% confidence interval) = 4,45 (2,25–8,80), р˂0,0001). Conclusion. Profile type of serum hepcidin, ferritin and iron concentrations together with transferrin saturation in the patients with spontaneous supratentorial intracerebral haemorrhage on the 1st day of hospital admission is the informative integrated marker for short-term prognosis during the course of conservative treatment.

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The prognostic value of tumor size in penile cancer: A Surveillance,Epidemiology, and End Results database study

10.21203/rs.3.rs-124807/v1 ◽

2020 ◽

Author(s):

Wenwen Zheng ◽

Zhiyu Zhang ◽

Xilei Xie ◽

Weiwei Zhu ◽

Kangqi Li ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Logistic Regression Analysis ◽

Tumor Size ◽

Prognostic Value ◽

Penile Cancer ◽

Node Metastasis ◽

End Results

Abstract Background: The objective of this study was to investigate the prognostic value of tumor size on cancer-specific mortality (CSM) and lymph node metastasis for patients with penile squamous cell carcinoma (PSCC).Method: The patients diagnosed with PSCC between 2004 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Restricted cubic spline functions were calculated to characterize the association between tumor size and the risk of CSM. The competing-risks model was used to evaluate the impact of tumor size on the cumulative incidence of CSM. The logistic regression analysis was performed to examine the association between tumor size and lymph node metastasis.Results: Totally, 1365 PSCC patients were analyzed, with 52.3% having tumors ≤30 mm, and 47.7% >30 mm. The restricted cubic splines showed that the risks of CSM increased as tumors enlarged. Following adjustment of competing events, the PSCC patients with tumors >30 mm were more likely to succumb to CSM in comparison with those with tumors ≤30 mm (hazard ratio [HR]=1.57, 95% confidence interval [CI]: 1.23-2.01, P<0.001). In subgroup analyses, tumor size >30 mm was significantly associated with an increased risk of CSM relative to tumor size ≤30 mm among patients with T1 (HR=1.56, 95%CI: 1.03-2.37, P=0.036) and T3 (HR=2.51, 95%CI: 1.41-4.45, P=0.002) classifications. On logistic regression analysis, tumors >30 mm were significantly associated with lymph node metastasis (odds ratio [OR]=1.46, 95% CI: 1.03-2.07, P=0.034).Conclusion: Larger tumors (>30 mm) were significantly associated with higher risks of CSM and increased likelihood of lymph node metastasis for PSCC patients, which could be integrated into the development of a staging system for penile cancer.

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Prognostic Value of Neutrophil-to-Lymphocyte Ratio in Patients With Sepsis

10.21203/rs.3.rs-706210/v1 ◽

2021 ◽

Author(s):

Xinyu Liao ◽

Fuxing Li ◽

Fuke Wang ◽

Guoliang Wang ◽

Yaxing Zheng ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Sofa Score ◽

Prognostic Value ◽

Laboratory Data ◽

Neutrophil To Lymphocyte Ratio ◽

Univariate Logistic Regression Analysis ◽

Lymphocyte Ratio ◽

Reactive Protein

Abstract Objective: We attempt to evaluate the role of neutrophil-to-lymphocyte ratio (NLR) in predicting 28-day mortality in patients with sepsis to investigate its prognostic value.Method: Relevant clinical and laboratory data of 91 healthy controls, 87 non-septic patients admitted to intensive care unit (ICU) and 127 septic patients on admission were collected, and septic patients were divided into survival (n=79) and death groups (n=48) according to their prognoses. NLR levels among different groups were compared and analyzed for associations with C-reactive protein (CRP), procalcitonin (PCT) and SOFA score. Univariate logistic regression analysis was used to assess the prognostic value of the NLR in patients with sepsis. Result: The NLR level was significantly higher in the septic patients compared to the case controls and healthy individuals (P < 0.05), and was much higher in septic patients who died (P < 0.05). ROC analysis indicated that the NLR had the best prognostic value for sepsis, with an AUC of 0.77 (95% CI: 0.69-0.84). Univariate logistic regression analysis suggested that NLR >8.25 was an independent risk factor for sepsis (odds ratio [OR] 6.39, P = 0.001). Correlation analysis suggested that the NLR was positively correlated with CRP, PCT and SOFA score.Conclusion: Peripheral serum NLR appeares to have a predictive value for 28-day mortality in patients with sepsis.

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The prognostic value of histology in ulcerative colitis in clinical remission with mesalazine

Therapeutic Advances in Gastroenterology ◽

10.1177/1756283x17722926 ◽

2017 ◽

Vol 10 (10) ◽

pp. 749-759 ◽

Cited By ~ 15

Author(s):

Giuseppe Frieri ◽

Brigida Galletti ◽

Mirko Di Ruscio ◽

Rachele Tittoni ◽

Annalisa Capannolo ◽

...

Keyword(s):

Ulcerative Colitis ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Clinical Remission ◽

Prognostic Value ◽

Activity Index ◽

Multivariate Logistic Regression Analysis ◽

Histological Activity

Background: The aim of the study was to compare the prognostic value of histological and endoscopic activity in patients with ulcerative colitis (UC). Methods: Patients in clinical remission for 1 year under treatment with mesalazine underwent a planned colonoscopy with biopsies. Histological activity was scored using the histological activity index (HAI). Endoscopic activity was scored using the Mayo endoscopic subscore (MES). The clinical course was evaluated measuring relapses needing steroids during a follow up of 3 years. Results: A total of 52 patients were enrolled into the study and followed up for 3 years. At baseline 29 patients (55.77%) had no endoscopic lesions, and 17 patients (32.69%) showed no histological alteration. At 3 years of follow up, overall, 26 patients (50%) were still in steroid-free remission. Using univariate logistic regression analysis, both histological (HAI ⩾ 1) and endoscopic activity (MES ⩾ 1) were significantly associated with outcome, showing, respectively, a relapse risk (odds ratio [OR]) 16.4 times higher than histological remission (HAI 0) (96% confidence interval [CI]: 3.2–84.3) and 6.3 times higher with respect to endoscopic remission (MES 0) (96% CI: 1.9–21.3). After multivariate logistic regression analysis, histological activity was the only factor significantly associated with outcome (OR 10.2; 95% CI: 1.7–59.4). Conclusions: Histological activity has the most powerful prognostic value in predicting the need for steroids in patients with UC in stable clinical remission on mesalazine. It could be considered as a target of therapy in UC.

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The Prognostic Value of Cardiac Troponin T in Different Age Groups of Traumatic Brain Injury Patients

10.21203/rs.3.rs-50058/v1 ◽

2020 ◽

Author(s):

Ruoran Wang ◽

Min He ◽

Yan Kang

Keyword(s):

Traumatic Brain Injury ◽

Logistic Regression ◽

Regression Analysis ◽

Brain Injury ◽

Elderly Patients ◽

Logistic Regression Analysis ◽

Prognostic Value ◽

Troponin T ◽

Age Groups ◽

Multivariate Logistic Regression Analysis

Abstract Background The cardiac dysfunction has been confirmed as a common non-neurological complication and associated with increased mortality in traumatic brain injury (TBI) patients. As a biological marker of cardiac injury, the cardiac troponin T (TnT) has been verified correlated with outcome of some non-traumatic brain injury patients. However, the prognostic value of TnT in TBI patients has not been clearly illustrated. We designed this study to explore the association between TnT and outcome of TBI patients in different age subgroups. Methods Patients diagnosed with TBI in a prospective critical care database were eligible for this study. Univariate logistic regression analysis was firstly performed to explore the relationship between included variables and mortality. Then, the real effect of TnT on outcome of different age subgroups was analyzed by multivariate logistic regression analysis adjusting the confounding effects of other significant risk factors. Finally, we draw receiver operating characteristic (ROC) curves to evaluate the prognostic value of TnT in different age groups of TBI patients. Results 520 patients were included in this study with mortality rate of 20.2%. There were 112 (21.5%) non-elderly patients (age < 65) and 408 (78.5%) elderly patients (age ≥ 65). Non-survivors had higher percentage of previous acute myocardial infarction (p = 0.019) and pupil no-reaction (p = 0.028; p = 0.011) than survivors. Survivors had higher GCS (p < 0.001) and lower TnT than non-survivors (p < 0.001). TnT was significantly associated with mortality in non-elderly patients (p = 0.031) but not in overall patients (p = 0.143) and elderly patients (p = 0.456) in multivariate logistic regression analysis. The AUC (area under the ROC curve) value of TnT in overall, non-elderly and elderly patients was 0.644, 0.693 and 0.632, respectively. Combining TnT with GCS increased the sensitivity of predicting mortality of both non-elderly and elderly TBI patients. Conclusion The prognostic value of TnT differed between elderly and non-elderly TBI patients. Level of TnT was associated with mortality of non-elderly TBI patients but not elderly patients. Combining the TnT with GCS could increase the sensitivity of prognosis evaluation.

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CONUT score is associated with mortality in patients with COVID-19: a retrospective study in Wuhan

10.21203/rs.3.rs-32889/v1 ◽

2020 ◽

Author(s):

Ruoran Wang ◽

Min He ◽

Jirong Yue ◽

Lang Bai ◽

Dan Liu ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Risk Factor ◽

Logistic Regression Analysis ◽

Roc Curve ◽

Prognostic Value ◽

Independent Risk Factor ◽

Multivariate Logistic Regression Analysis ◽

Operating Characteristics ◽

Conut Score

Abstract Background The coronavirus disease 2019 (COVID-19) pneumonia, outbreak in Wuhan, China, has led to a global pandemic. The high mortality of COVID-19 patients makes it significant to evaluate possible disease progression. This study was designed to explore the prognostic value of Controlling Nutritional Status (CONUT) score in patients with COVID-19. Methods Patients diagnosed with COVID-19 of a single center in Wuhan, China from January 2020 to February 2020 were enrolled in this study. Logistic regression analysis was performed to find independent risk factor of mortality. Receiver operating characteristics (ROC) curve was drawn to evaluate the prognostic value of CONUT score. Results Among 442 included patients, there were 79 non-survivors with mortality of 17.9%. Compared with survivors, the median age (p < 0.001) and male ratio (p = 0.042) were higher in non-survivors. Non-survivors had higher incidence of comorbidities including hypertension (p < 0.001), chronic lung disease (p = 0.001) and cardiovascular disease (p = 0.005). Complications such as respiratory failure(p < 0.001), acute kidney injury (AKI) (p < 0.001) occurred more frequently in non-survivors. Multivariate logistic regression analysis showed that CONUT (p = 0.002), lactate dehydrogenase (LDH) (p < 0.001), C-reactive protein (CRP) (p = 0.020) were risk factor of mortality in COVID-19 patients. Area under the ROC curve (AUC) of CONUT and Nutrition risk screening 2002 (NRS2002) score were 0.813 and 0.795, respectively. Comprised of CONUT, LDH, CRP, the constructed prognostic model had higher AUC of 0.923 (Z = 3.5210, p < 0.001). Conclusion CONUT is an independent risk factor of mortality in COVID-19 patients. Evaluating CONUT is beneficial for clinicians to predict the progression of COVID-19 patients and strengthen monitoring and management to improve prognosis.

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The prognostic value of tumor size in penile cancer: A Surveillance, Epidemiology, and End Results database study

10.21203/rs.3.rs-124807/v2 ◽

2021 ◽

Author(s):

Wenwen Zheng ◽

Zhiyu Zhang ◽

Wei Jiang ◽

Jiaojiao Chen ◽

Shengqiang Yu ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Logistic Regression Analysis ◽

Tumor Size ◽

Prognostic Value ◽

Penile Cancer ◽

Node Metastasis ◽

End Results

Abstract Background The objective of this study was to investigate the prognostic value of tumor size on cancer-specific mortality (CSM) and lymph node metastasis for patients with penile squamous cell carcinoma (PSCC). Methods The patients diagnosed with PSCC between 2004 and 2015 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Restricted cubic spline functions were calculated to characterize the association between tumor size and the risk of CSM. The competing-risks model was used to evaluate the impact of tumor size on the cumulative incidence of CSM. The logistic regression analysis was performed to examine the association between tumor size and lymph node metastasis. Results Totally, 1365 PSCC patients were analyzed, with 52.3% having tumors ≤ 30 mm, and 47.7% >30 mm. The restricted cubic splines showed that the risks of CSM increased as tumors enlarged. Following adjustment of competing events, the PSCC patients with tumors > 30 mm were more likely to succumb to CSM in comparison with those with tumors ≤ 30 mm (hazard ratio [HR] = 1.57, 95% confidence interval [CI]: 1.23–2.01, P < 0.001). In subgroup analyses, tumor size > 30 mm was significantly associated with an increased risk of CSM relative to tumor size ≤ 30 mm among patients with T1 (HR = 1.56, 95%CI: 1.03–2.37, P = 0.036) and T3 (HR = 2.51, 95%CI: 1.41–4.45, P = 0.002) classifications. On logistic regression analysis, tumors > 30 mm were significantly associated with lymph node metastasis (odds ratio [OR] = 1.46, 95% CI: 1.03–2.07, P = 0.034). Conclusions Larger tumors (> 30 mm) were significantly associated with higher risks of CSM and increased likelihood of lymph node metastasis for PSCC patients, which could be integrated into the development of a staging system for penile cancer.

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Abstract TP332: Multi-Institutional Validation of the NAG Scale for Predicting Hematoma Expansion in Acute Intracerebral Hemorrhage Patients

Stroke ◽

10.1161/str.51.suppl_1.tp332 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kenichi Sakuta ◽

Takeo Sato ◽

Teppei Komatsu ◽

Kenichiro Sakai ◽

Hidetaka Mitsumura ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Intracerebral Hemorrhage ◽

Logistic Regression Analysis ◽

Poor Prognosis ◽

Ct Scans ◽

Hematoma Expansion ◽

Hospital Death ◽

Absolute Increase

Background and Purpose: Early hematoma expansion (HE) is seen in about 30% of intracerebral hemorrhage (ICH) patients, but detecting those patients with high risk of HE is challenging. The NAG scale was previously published as the simple predictive scale for HE in acute ICH patients. Multi-institutional validation for utility of the scale was the aim of this study. Methods: We retrospectively reviewed consecutive primary ICH patients, who were admitted between September 2016 and December 2018 to Jikei University Hospital or Kashiwa Hospital, Japan. NAG scale is consist of 3 factors based on examination on admission; NIHSS ≥10, Anticoagulant agents use, Glucose ≥133 mg/dl, with 1 point assigned for each parameter. Patients received an initial non-contrast computed tomography (CT) scan within 24 hours from symptom onset, and underwent follow-up CT scans at 6 hours, 24 hours, and 7 days after admission. The HE was defined as an increment in hemorrhage volume >33% or an absolute increase >6 mL on follow-up CT scans. Poor prognosis was defined as modified Rankin Scale 4-6 at discharge. We performed logistic regression analysis and receiver operating characteristic curves to determine discrimination ability of the score. Results: A total of 142 patients (96 men; median age 64 years; median NIHSS 11) were included in our study, and HE was observed in 38 patients (27%). Higher NAG sores were related to HE (P<0.001), poor prognosis (P<0.001), and in-hospital death (P<0.001). The C statistic was 0.72 (95% confidence interval [CI], 0.63-0.82) for HE, 0.67 (95% CI, 0.58-0.76) for poor prognosis, and 0.85 (95% CI, 0.74-0.95) for in-hospital death. Multivariate logistic regression analysis with known risk factors showed the NAG scale was the independent factor for HE (Odds ratio, 2.95; 95% CI, 1.57-5.52; P = 0.001). Conclusion: Multi-institutional validation of the NAG scale showed good discrimination.

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