• Hong Yang, Bin Zhang, Chunxian Peng, Chun Yu, and Xiaolin Mou.
• Department of Infectious Diseases, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang, China.
• Brit J Hosp Med. 2024 Dec 30; 85 (12): 1101-10.

AbstractAims/Background Decompensated cirrhosis is characterized by the progression of cirrhosis from an asymptomatic state to elevated portal pressure and marked deterioration of liver function. This pathological condition progresses rapidly following onset, significantly raising the risk for mortality. The aim of this study is to explore the association between serum lactate concentrations and mortality rates in individuals with hepatitis B-induced decompensated cirrhosis and to evaluate its potential as a clinical prognostic indicator. Methods This retrospective analysis involved 200 individuals (134 men and 66 women) diagnosed with decompensated cirrhosis related to hepatitis B and hospitalized between March 2017 and May 2023. Out of these patients, 162 survived while 38 did not. Clinical information and laboratory results, including the Model for End-Stage Liver Disease (MELD) score, Child-Pugh score, and serum lactate levels, were collected. Logistic regression was applied to identify mortality risk factors from the patient sample and groups categorized according to gender. The predictive value of serum lactate levels for mortality was assessed using the area under the curve (AUC), i.e., receiver operating characteristic (ROC) curve. Results The surviving patient group showed significantly lowered MELD scores, Child-Pugh scores, and serum lactate levels compared to those who were deceased (p < 0.05). Multivariate analysis revealed that the MELD score, Child-Pugh score, and serum lactate levels were independent predictors of mortality in patients with decompensated hepatitis B cirrhosis, with odds ratios (OR) of 1.321, 1.432, and 49.082, respectively (p = 0.012, 0.028, and <0.001, respectively). Additionally, the OR for serum lactate levels was notably higher in female patients compared to male patients (46.824 vs. 30.451). Thus, the MELD score, Child-Pugh score, and serum lactate levels are effective predictors for mortality in cirrhosis patients (AUCs = 0.628, 0.675, and 0.809; p = 0.014, 0.001, and <0.001, respectively), with serum lactate levels showing the most excellent predictive efficacy profile (sensitivity 65.8% and specificity 97.5%). Additionally, the AUC value for serum lactate levels was lower in male patients (0.785) compared to female patients (0.875), indicating that changes in serum lactate levels were more sensitive in female patients. In summary, serum lactate concentration is a prognostic indicator of mortality in individuals with decompensated cirrhosis due to hepatitis B, exhibiting higher predictive significance in female patients. Conclusion Deceased patients with decompensated cirrhosis linked to hepatitis B exhibit markedly increased serum lactate levels. Thus, monitoring serum lactate levels offers an effective tool for predicting patient prognosis, exhibiting higher sensitivity for disease detection in female patients.

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