Table 1
Demographic, basic clinical characteristics, and baseline information
| Factors | Total (n = 194) | Non-LVDD group (n = 102) | LVDD group (n = 92) | t/Z/χ2 | P |
|---|---|---|---|---|---|
| Demographics | |||||
| Age, M(P25, P75) years | 55.0(47.0, 60.2) | 49.0(43.0, 57.3) | 59.0(53.2, 65.7) | −5.936 | <0.001 |
| Male sex, n(%) | 135(69.6) | 77(75.5) | 58(63) | 3.541 | 0.060 |
| Han ethnicity, n(%) | 177(91.2) | 96(94.1) | 81(88) | 2.232 | 0.135 |
| BMI, M(P25, P75) kg/cm2 | 22.0(20.3, 24.3) | 22.0(20.0, 23.9) | 22.4(20.4, 24.6) | −0.807 | 0.420 |
| Smoking history, n(%) | |||||
| Yes | 103(53.1) | 60(58.9) | 43(46.7) | 3.204 | 0.202 |
| No | 84(43.3) | 38(37.3) | 46(50) | ||
| Quit | 7(3.6) | 4(3.9) | 3(3.3) | ||
| Alcohol consumption, n(%) | |||||
| Yes | 82(42.3) | 48(47.1) | 34(37) | 2.849 | 0.241 |
| No | 91(46.9) | 42(41.2) | 49(53.3) | ||
| Quit | 21(10.8) | 12(11.8) | 9(9.8) | ||
| Family history of hepatic malignant, n(%) | 22(11.3) | 13(12.7) | 9(9.8) | 0.422 | 0.516 |
| Basic clinical information | |||||
| Etiology of cirrhosis, n(%) | 7.603 | 0.055 | |||
| Viral hepatitis | 144(74.2) | 83(81.4) | 61(66.2) | ||
| Alcohol | 17(8.8) | 6(5.9) | 11(12) | ||
| Virus + Alcohol | 18(9.3) | 9(8.8) | 9(9.8) | ||
| Others | 15(7.7) | 4(3.9) | 11(12) | ||
| Hepatic malignant, n(%) | 124(63.9) | 31(30.4) | 39(42.4) | 3.020 | 0.082 |
| EGVB, n(%) | 22(11.3) | 12(11.8) | 10(10.9) | 0.039 | 0.844 |
| Systolic blood pressure, M(P25, P75) mmHg | 115.0(104.0, 128.0) | 115.0(101.7, 122.0) | 117.0(105.0, 134.0) | −1.752 | 0.080 |
| Diastolic blood pressure, M(P25, P75) mmHg | 72.0(66.0, 82.0) | 71.0(65.0, 78.0) | 74.0(68.0, 85.0) | −2.066 | 0.039 |
| Heart rate, M(P25, P75) bpm | 82.0(72.0, 92.0) | 80.0(72.0, 91.0) | 83.5(71.3, 92.0) | −0.334 | 0.738. |
| Liver function | |||||
| CTP, M(P25, P75) scores | 9.0(8.0, 11.0) | 9.0(7.0, 11.0) | 9.0(8.0, 11.0) | −0.889 | 0.374 |
| MELD, M(P25, P75) scores | 12.6(10.0, 17.0) | 12.4(10.1, 16.4) | 12.6(9.5, 15.7) | −0.517 | 0.605 |
| Laboratory findings | |||||
| TBIL, M(P25, P75) μmol/L | 31.9(18.2, 64.5) | 32.2(18.0, 77.8) | 31.6(18.2, 58.1) | −0.142 | 0.887 |
| DBIL, M(P25, P75) μmol/L | 14.4(7.8, 36.0) | 13.3(7.5, 44.6) | 14.6(7.8, 28.8) | −0.187 | 0.852 |
| ALT, M(P25, P75) U/L | 35.0(23.0, 75.0) | 37.0(24.8, 72.3) | 32.5(23.0, 78.0) | −0.940 | 0.347 |
| AST, M(P25, P75) U/L | 54.0(37.8, 120.0) | 58.5(37.0, 109.75) | 51.0(38.0, 132.7) | −0069 | 0.945 |
| GGT, M(P25, P75) U/L | 96.0(40.8, 169.6) | 80.5(38.7, 156.3) | 103.5(46.4, 162.7) | −1.247 | 0.212 |
| ALP, M(P25, P75) U/L | 142.0(102.8, 201.2) | 142.0(105.2, 195.0) | 153(100.0, 217.0) | −0.513 | 0.608 |
| TP, M(P25, P75) g/L | 61.6(57.5, 67.4) | 61.8(57.0, 67.1) | 61.3(57.7, 68.2) | −0.133 | 0.894 |
| PALB, M(P25, P75) g/L | 76.1(49.1, 110.3) | 77.0(46.4, 105.4) | 71.1(52.1, 112.8) | −0.428 | 0.669 |
| ALB, M(P25, P75) g/L | 29.5(25.7, 33.3) | 30.2(27.3, 35.0) | 28.2(24.8, 31.8) | −2.596 | 0.009 |
| GLOB, M(P25, P75) g/L | 31.2(27.2, 36.7) | 30.4(27.0, 35.5) | 32.1(28.0, 37.8) | −1.629 | 0.103 |
| CHE, M(P25, P75) U/L | 2978.0(2136.8, 4008.3) | 2978.0(2214.0, 3999.0) | 2886.5(2089.7, 4253.5) | −0.636 | 0.525 |
| PT, M(P25, P75) sec | 16.6(15.3, 18.4) | 16.6(15.3, 18.4) | 16.6(15.4, 18.1) | −0.236 | 0.814 |
| PTA, M(P25, P75) % | 59.8(68.0, 50.7) | 59.7(50.1, 69.9) | 59.8(51.0, 68.0) | −0.008 | 0.994 |
| INR, M(P25, P75) | 1.4(1.3, 1.6) | 1.4(1.2, 1.6) | 1.4(1.2, 1.5) | −0.003 | 0.998 |
| WBC, M(P25, P75) ×109/L | 4.4(3.1, 7.3) | 4.1(2.7, 7.9) | 4.5(3.4, 7.4) | −1.694 | 0.092 |
| RBC, (x̅±s) ×1012/L | 3.6±0.8 | 3.6±0.7 | 3.5±0.8 | 0.556 | 0.579 |
| HGB, M(P25, P75) g/L | 115.0(97.8, 133.0) | 117.5(95.0, 132.3) | 115.0(99.3, 133.0) | 0.080 | 0.937 |
| PLT, M(P25, P75) ×109/L | 89.5(59.7, 141.5) | 83.5(53.7, 139.0) | 100.0(71.2, 142.5) | −1.580 | 0.114 |
| K, (x̅±s) mmol/L | 3.7±0.5 | 3.7±0.5 | 3.8±0.5 | −2.053 | 0.041 |
| Na, M(P25, P75) mmol/L | 138.9(136.1, 141.1) | 138.9(136.5, 141.2) | 108.9(105.8, 140.8) | −0.690 | 0.490 |
| Ca, (x̅±s) mmol/L | 2.1±0.2 | 2.0±0.1 | 2.09±0.2 | −0.752 | 0.453 |
| CL, M(P25, P75) mmol/L | 106.9(136.1, 141.1) | 106.9(103.9, 109.4) | 106.5(103.1, 109.4) | −0.491 | 0.630 |
| CO2, M(P25, P75) mmol/L | 23.3(21.5, 25.2) | 23.2(21.7, 24.9) | 23.4(21.3, 25.2) | −0.122 | 0.903 |
| BUN, M(P25, P75) mmol/L | 4.8(3.8, 7.1) | 4.5(3.6, 6.5) | 5.2(4.1, 8.5) | −2.768 | 0.006 |
| Crea, M(P25, P75) μmol/L | 61.5(52.0, 74.0) | 60.0(49.0, 73.0) | 63.5(53.0, 80.7) | −1.515 | 0.130 |
| UA, M(P25, P75) μmol/L | 295.0(244.0, 375.2) | 290.5(243.7, 355.2) | 301(242.2, 406.0) | −0.946 | 0.344 |
| FPG, M(P25, P75) mmol/L | 5.6(4.9, 7.4) | 5.5(4.8, 7.1) | 5.7(5.0, 8.2) | −1.375 | 0.169 |
| TG, M(P25, P75) mmol/L | 0.8(0.6, 1.3) | 0.8(0.5, 1.2) | 0.8(0.6, 1.2) | −1.204 | 0.229 |
| CHOL, M(P25, P75) mmol/L | 3.2(2.6, 3.9) | 3.1(2.5, 3.5) | 3.1(2.7, 4.2) | −2.427 | 0.015 |
| HDL-C, M(P25, P75) mmol/L | 0.8(0.5, 1.1) | 0.7(0.4, 1.0) | 0.7(0.5, 1.0) | −0.552 | 0.581 |
| LDL-C, M(P25, P75) mmol/L | 1.9(1.4, 2.5) | 1.8(1.3, 2.2) | 2.0(1.4, 2.8) | −2.957 | 0.003 |
| CEA, M(P25, P75) μg/L | 3.2(2.1, 4.8) | 3.0(2.0, 4.5) | 3.6(2.3, 5.0) | −2.300 | 0.021 |
| AFP, M(P25, P75) μg/L | 6.4(3.1, 66.7) | 6.3(3.2, 38.9) | 6.8(2.8, 100.4) | −0.391 | 0.696 |
| CA125, M(P25, P75) U/mL | 107.5(31.5, 276.5) | 76.8(27.9, 228.2) | 152.9(40.9, 442.8) | −2.944 | 0.003 |
| CA199, M(P25, P75) U/mL | 31.8(17.4, 68.5) | 31.5(16.3, 72.9) | 34.0(18.3, 67.2) | −0.210 | 0.834 |
| LYMP, M(P25, P75) ×109/L | 0.9(0.6, 1.3) | 0.9(0.5, 1.2) | 0.9(0.5, 1.2) | −0.344 | 0.730 |
| HCT, (x̅±s) % | 33.0±7.6 | 33.0±7.1 | 33.0±8.1 | 0.013 | 0.990 |
| RDW, M(P25, P75) fL | 15.7(14.4, 17.0) | 15.7(14.4, 17.2) | 15.3(14.2, 16.9) | −0.613 | 0.540 |
[i] Note: Abbreviations: Body Mass Index (BMI), Esophageal GastroVariceal Bleeding (EGVB), White Blood Cell Count (WBC), Red Blood Cell Count (RBC), Hemoglobin (HGB), Platelet (PLT), Potassium (K), Sodium (Na), Blood Urea Nitrogen (BUN), Creatinine (Crea), Total Bilirubin (TBIL), Direct Bilirubin (DBIL), Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Albumin (ALB), International Normalized Ratio (INR), Lymphocyte Count (LYMP), Hematocrit (HCT), Red Blood Cell Distribution Width (RDW), Calcium (Ca), Chloride (CL), Carbon Dioxide Content (CO2), Uric Acid (UA), Fasting Plasma Glucose (FPG), Gamma-Glutamyl Transferase (GGT), Alkaline Phosphatase (ALP), Total Protein (TP), Prealbumin (PALB), Globulin (GLOB), Cholinesterase (CHE), Triglyceride (TG), CHOL, High-Density Lipoprotein Cholesterol (HDL-C), Low-Density Lipoprotein Cholesterol (LDL-C), Carcinoembryonic Antigen (CEA), Alpha-Fetoprotein (AFP), Cancer Antigen 125 (CA125), Cancer Antigen 19-9 (CA199), Prothrombin Time (PT), Prothrombin Time Activity (PTA).
Table 2
Cardiac parameters of TTE [M(P25, P75)]
| Parameters of TTE | Total (n = 194) | Non-LVDD group (n = 102) | LVDD group (n = 92) | t/Z/χ2 | P |
|---|---|---|---|---|---|
| Aortic Valve Ring Internal Diameter, mm | 23.0(22.0, 25.0) | 23.0(22.0, 25.0) | 24.0(21.2, 25.7) | −1.382 | 0.173 |
| Ascending Aorta Internal Diameter, mm | 25.0(23.0, 27.0) | 25.0(23.0, 26.0) | 25.5(23.0, 28.0) | −1.947 | 0.052 |
| Mitral annulus diameter (MAD), mm | 20.0(18.0, 22.0) | 20.0(18.0, 22.0) | 21.0(19.0, 22.0) | −0.897 | 0.370 |
| Left Cardiac Chamber Diameter (LCD), mm | 28.0(26.0, 31.0) | 28.0(25.0, 31.0) | 28.0(26.0, 31.0) | −0.435 | 0.663 |
| Intrapericardial Pressure, mmHg | 42.0(38.7, 46.0) | 43.0(39.0, 46.0) | 42.0(39.0, 46.0) | −0.785 | 0.432 |
| Right Ventricular Diameter, mm | 20.0(18.0, 22.0) | 20.0(18.0, 22.0) | 20.0(18.0, 21.7) | −0.784 | 0.433 |
| Right Atrial Diameter, mm | 32.0(30.0, 35.0) | 32.5(30.0, 35.0) | 32.0(29.0, 34.0) | −1.255 | 0.210 |
| Right Ventricular Outflow Tract Diameter (RVOTD), mm | 22.0(20.0, 24.0) | 22.0(20.0, 24.0) | 23.0(21.0, 25.0) | −1.573 | 0.116 |
| Interventricular Septum Thickness, mm | 9.0(8.0, 10.0) | 9.0(8.0, 10.0) | 9.0(8.0, 10.0) | −1.385 | 0.166 |
| Left Posterior Wall Thickness, mm | 9.0(8.0, 10.0) | 9.0(8.0, 10.0) | 9.0(8.0, 10.0) | −1.015 | 0.310 |
| end-diastolic volume (EDV), ml | 100.5(89.0, 117.2) | 102.0(89.0, 113.0) | 99.5(89.5, 121.0) | −0.320 | 0.749 |
| end-systolic volume (ESV), ml | 31.0(23.0, 40.0) | 31.0(24.0, 40.0) | 32.0(23.0, 42.5) | −0.238 | 0.812 |
| ejection fraction (EF), % | 68.0(64.0, 73.0) | 69.0(64.0, 72.2) | 67.0(63.0, 73.0) | −0.792 | 0.428 |
| Fractional Shortening, % | 38.0(34.0, 42.0) | 38.0(35.0, 42.0) | 37.0(34.0, 42.7) | −0.921 | 0.357 |
| stroke volume (SV), ml | 70.0(61.0, 80.0) | 69.5(60.0, 78.6) | 71.0(61.0, 80.0) | −0.353 | 0.724 |
| E-point Septal Separation, mm | 5.0(5.0, 6.0) | 5.0(5.0, 6.0) | 5.0(5.0, 6.0) | −1.358 | 0.174 |
| Pulmonary Artery Systolic Pressure, mmHg | 24.0(22.7, 28.0) | 24.0(21.0, 28.0) | 24.0(23.0, 28.0) | −0.116 | 0.908 |
| Tricuspid Regurgitation (peak velocity), m/s | 220.0(210.0, 246.0) | 220.0(200.0, 240.0) | 220.0(210.0, 240.0) | −0.275 | 0.783 |
| Pulmonary Artery Valve Forward Flow Rate, m/s | 113.0(96.7, 131.0) | 111.0(94.7, 130.0) | 113.0(100.0, 134.2) | −0.899 | 0.369 |
| Pulmonary Pulmonic Valve Forward Flow Rate, m/s | 90.0(80.0, 104.5) | 90.5(80.7, 102.2) | 90.0(80.0, 106.7) | −0.193 | 0.847 |
| E-wave/A-wave ratio (E/A) | 0.9(0.7, 1.3) | 1.2(1.0, 1.3) | 0.7(0.6, 0.8) | −9.412 | <0.001 |
Figure 1.
Lasso regression for screening potential influencing factors of 1-year mortality risk.
Note for figure 1: (A) and (B) belong to total cohort, and (C) and (D) belong to subgroup without hepatic malignancy. (A) and (C) are lasso coefficient plots. The vertical axis represents model coefficients, the lower horizontal axis shows the logarithm of λ, and the upper horizontal axis indicates the number of variables corresponding to each λ. λ is the regularization parameter, which controls the degree of penalty applied to model coefficients, thereby balancing the model's fitting ability and complexity. As λ increases, the penalty on model coefficients intensifies, compressing more coefficients toward zero or even setting them to zero. This achieves variable selection by eliminating relatively unimportant predictors, while variables not compressed to zero become the final retained model variables. (B) and (D) are 10-fold cross-validation plots. The vertical axis, Binomial Deviance (also known as Log loss), represents model error. This loss function measures the discrepancy between predicted and observed outcomes, quantifying the quality of model predictions. The lower horizontal axis displays the logarithm of λ, while the upper horizontal axis shows the number of variables corresponding to each λ. The left dashed vertical line indicates λ.min, where model error is minimized, but this model may be relatively complex and carry some risk of overfitting. The right dashed line corresponds to λ.1 standard error (λ.1se), the λ value where the evaluation metric is one standard error larger than that at λ.min. Models at λ.1se sacrifice some predictive accuracy (slightly higher than optimal prediction error) in exchange for a relatively simpler, more stable model with reliable generalization capabilities. Using 1-year mortality risk as the dependent variable, this study selected predictive models from 75 candidate variables across five dimensions (including demographics, basic clinical information, liver functions, laboratory findings, and cardiac parameters of TTE). After Lasso regression, the log(λ.min) and log(λ.1se) for the total cohort were −3.56 and −2.90, corresponding to 19 and 13 model variables, respectively, therefore, the 13 variables associated with log(λ.1se) were identified as potential influencing factors. For the subgroup without hepatic malignancy, log(λ.min) and log(λ.1se) were −3.10 and −2.54, corresponding to 12 and 10 model variables, respectively, so this study adopted the 10 variables corresponding to log(λ.1se) as potential influencing factors.
Table 3
Univariate and multivariate Cox regression of 1-year mortality risk
| Participants | Factors | Univariate Cox | Multivariate Cox | ||||
|---|---|---|---|---|---|---|---|
| HR | 95% CI | P-value | HR | 95% CI | P-value | ||
| Total | BMI | 0.917 | 0.851–0.987 | 0.021 | 0.876 | 0.808–0.950 | 0.001 |
| Hepatic malignancy | 2.579 | 1.635–4.069 | <0.001 | 1.863 | 1.107–3.141 | 0.019 | |
| MAD | 1.069 | 0.999–1.155 | 0.088 | ||||
| RVOTD | 1.087 | 1.039–1.137 | <0.001 | 1.077 | 1.018–1.139 | 0.008 | |
| LVDD | 2.447 | 1.522–3.933 | <0.001 | 2.109 | 1.279–3.478 | 0.003 | |
| WBC | 1.114 | 1.065–1.165 | <0.001 | ||||
| PLT | 1.004 | 1.002–1.006 | <0.001 | 1.003 | 1.0002–1.0062 | 0.035 | |
| Na | 0.886 | 0.839–0.936 | <0.001 | ||||
| DBIL | 1.004 | 1.001–1.007 | 0.001 | ||||
| GGT | 1.001 | 1.001–1.002 | 0.007 | ||||
| ALP | 1.002 | 1.001–1.003 | <0.001 | ||||
| CHE | 0.352 | 0.213–0.580 | <0.001 | ||||
| INR | 4.713 | 2.197–10.110 | <0.001 | 7.031 | 2.504–19.748 | <0.001 | |
| Without hepatic malignancy | Etiology of cirrhosis | 3.874 | 1.482–10.129 | 0.006 | |||
| viral hepatitis | 1 | - | - | ||||
| alcohol | 2.169 | 0.929–5.064 | 0.074 | ||||
| virus+alcohol | 0.423 | 0.056–3.106 | 0.398 | ||||
| others | 3.150 | 1.332–7.448 | 0.009 | ||||
| RVOTD | 1.061 | 1.017–1.107 | 0.006 | ||||
| LVDD | 3.020 | 1.441–6.332 | 0.003 | 2.351 | 1.040–5.313 | 0.040 | |
| RDW | 1.215 | 1.063–1.388 | 0.004 | ||||
| CO2 | 0.886 | 0.828–0.948 | <0.001 | 0.840 | 0.764–0.922 | <0.001 | |
| CREA | 1.003 | 1.001–1.004 | 0.003 | ||||
| TBIL | 1.005 | 1.002–1.008 | <0.001 | 1.007 | 1.003–1.011 | 0.001 | |
| CHE | 0.248 | 0.114–0.540 | <0.001 | ||||
| INR | 10.400 | 2.963–36.510 | <0.001 | ||||
| CTP score | 1.291 | 1.116–1.494 | <0.001 | ||||
Figure 2.
K-M curves showing the predictive value of LVDD vs. non-LVDD for 1-year mortality risk. (A) Total participants; (B) Without hepatic malignancy; (C) With hepatic malignancy.
Figure 3.
Time-dependent ROC curves showing the efficacy of LVDD in predicting 1-year mortality. (A) Overall participants; (B) Subgroup without hepatic malignancy.
Figure 4.
The intrinsic relationship between cirrhosis and LVDD and corresponding mechanisms.