Left Ventricular Diastolic Dysfunction Increases the Risk of Medium-term Mortality in Patients with Cirrhotic Ascites

Li, Sheng-Hao; Zhang, Lu; Li, Hong-Juan; Li, Ye; Zheng, Yan-Min; Wang, Qing-Qing

doi:10.2478/rjim-2025-0022

Figures & Tables

Lasso regression for screening potential influencing factors of 1-year mortality risk. (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.

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.

Time-dependent ROC curves showing the efficacy of LVDD in predicting 1-year mortality. (A) Overall participants; (B) Subgroup without hepatic malignancy

The intrinsic relationship between cirrhosis and LVDD and corresponding mechanisms.

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

Demographic, basic clinical characteristics, and baseline information

Factors	Total (n = 194)	Non-LVDD group (n = 102)	LVDD group (n = 92)		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)	3.204	0.202
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)	2.849	0.241
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

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

Left Ventricular Diastolic Dysfunction Increases the Risk of Medium-term Mortality in Patients with Cirrhotic Ascites

Figures & Tables

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Univariate and multivariate Cox regression of 1-year mortality risk

Demographic, basic clinical characteristics, and baseline information

Cardiac Parameters of TTE [M(P25, P75)]

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