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. 2024 Aug 6;12(8):1783.
doi: 10.3390/biomedicines12081783.

Prognostic Value of High-Density Lipoprotein Cholesterol in Patients with Overt Hepatic Encephalopathy

Ke Shi  1 , Yufei Bi  1 , Xiaojing Wang  1 , Yanqiu Li  1 , Xuanwei Zeng  1 , Ying Feng  1 , Xianbo Wang  1
Affiliations

Prognostic Value of High-Density Lipoprotein Cholesterol in Patients with Overt Hepatic Encephalopathy

Ke Shi et al. Biomedicines. .

Abstract

Overt hepatic encephalopathy (OHE), a serious complication of liver cirrhosis, is associated with alterations in lipid and lipoprotein metabolism. We evaluated the correlation between high-density lipoprotein cholesterol (HDL-C) levels and transplant-free (TF) mortality in patients with OHE. Patients with OHE admitted to Beijing Ditan Hospital between January 2010 and August 2016 (n = 821) and between September 2016 and December 2020 (n = 480) were included in the training and validation sets, respectively. Independent predictors were explored by a multivariate Cox regression analysis, and the area under the receiver operating characteristic curve (AUC) was used to assess the prognostic value of these factors. The prognostic value of HDL-C was good (AUC at 1 year: 0.745) and was equivalent to that of the Model for End-Stage Liver Disease (MELD) score (AUC at 1 year: 0.788). The optimal threshold values for HDL-C and MELD were 0.5 mmol/L and 17, respectively. The 1-year TF mortality rates in the low-risk (HDL-C ≥ 0.5 mmol/L and MELD < 17) and high-risk (HDL-C < 0.5 mmol/L and MELD ≥ 17) groups were 7.5% and 51.5% in the training set and 10.1% and 48.2% in the validation set, respectively. HDL-C level < 0.5 mmol/L and MELD score > 17 can facilitate the identification of high-risk patients and provide a basis for timely treatment.

Keywords: hepatic encephalopathy; high-density lipoprotein cholesterol; prognosis; transplant-free mortality.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study flow diagram. OHE, overt hepatic encephalopathy; HIV, human immunodeficiency virus; HDL-C, high-density lipoprotein cholesterol.
Figure 2
Figure 2
Predictive values of independent risk factors and relationship between HDL-C and prognosis in training cohort. AUCs of HDL-C, NLR, and MELD score predicting 1- (A), 3- (B), and 12-month (C) transplant-free (TF) mortality. Relationships between HDL-C and 1- (D), 3- (E), and 12-month (F) TF mortality in patients (unadjusted). Red lines represent references for HR, and red areas represent 95% CI. AUC, area under receiver operating characteristic curve; HDL-C, high-density lipoprotein cholesterol; MELD, Model for End-Stage Liver Disease; TF, transplant-free; NLR, neutrophil–lymphocyte ratio; HR, hazard ratio; CI, confidence interval.
Figure 3
Figure 3
Scatter plot and risk stratification in patients with OHE in training set. (A) Distributions of patients with OHE who died and survived. (B) One-year survival probability in patients with HDL-C level < 0.5 mmol/L and ≥0.5 mmol/L. (C) One-year survival probability in patients with MELD score < 17 and ≥17. (D) Survival probability of patients in low-, medium-, and high-risk groups. (E) Predictive ability of different indicators for 1-year mortality in patients with ascites. (F) Survival probability of patients with ascites in low-, medium-, and high-risk groups. HDL-C, high-density lipoprotein cholesterol; MELD, Model for End-Stage Liver Disease; OHE, overt hepatic encephalopathy.
Figure 4
Figure 4
The Cox proportional hazards analysis of the prognostic value of HDL-C levels in various subgroups. HR was adjusted for age, sex, ascites, NLR, and the MELD score in the multivariate model. HDL-C, high-density lipoprotein cholesterol; MELD, Model for End-Stage Liver Disease; HR, hazard ratio.
Figure 5
Figure 5
Predictive values of different risk factors and risk stratification in the validation cohort. ROC curves of HDL-C levels, NLR, and MELD scores in predicting 1- (A), 3- (B), and 12-month TF mortality (C). (D) Survival probability in patients with HDL-C values of <0.5 mmol/L and ≥0.5 mmol/L. (E) Survival probabilities for patients with MELD scores of <17 and ≥17. (F) Survival probabilities of patients in the low-, medium-, and high-risk groups. ROC, receiver operating characteristic; HDL-C, high-density lipoprotein cholesterol; NLR, neutrophil–lymphocyte ratio; MELD, Model for End-Stage Liver Disease; TF, transplant-free.
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