Development of a novel combined model integrating electrolyte indicators to evaluate ascites recompensation in HBV-related decompensated cirrhosis.

Objective: Ascites is one of the common complications of hepatitis B virus (HBV) -related cirrhosis, which predicts a poor clinical prognosis for cirrhosis patients. Electrolyte disturbance is often observed in such patients. In our study, we developed a novel combined model integrating electrolyte indicators to evaluate the prognostic value of electrolyte indicators in ascites recompensation in HBV-related decompensated cirrhosis.

Methods: A retrospective cohort of 350 patients with HBV-related decompensated cirrhosis and ascites was categorized into recompensated (n=117) and non-recompensated (n=233) groups based on 2-year outcomes. Participants were randomly divided into training (n=263) and validation (n=87) cohorts. Multivariable logistic regression identified independent predictors, followed by nomogram construction. Model performance was assessed using receiver operating characteristic-area under the curve, calibration curves, and decision curve analysis.

Results: Serum chloride (OR=1.08, P<0.01), serum calcium (OR=8.3, P<0.01), and hepatic encephalopathy (HE) (OR=0.06, P<0.01) were independent predictors of recompensation. The nomogram demonstrated moderate predictive accuracy in the validation cohort (AUC=0.762; 95% CI: 0.653-0.871), with balanced sensitivity (59.3%) and specificity (70.0%). Calibration curves confirmed good agreement between predicted and observed outcomes (P>0.05). DCA indicated superior clinical utility across risk thresholds (10-80%).

Conclusion: A nomogram integrating serum chloride, calcium, and HE effectively predicts recompensation in HBV-related decompensated cirrhosis with ascites, offering actionable guidance for clinical management.