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.

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.

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 %).

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

Chronic hepatitis B

Decompensated cirrhosis

Electrolyte

Predictors

Recompensation

Stable improvement of liver function tests

© 2025 Published by Elsevier Inc. on behalf of Southern Society for Clinical Investigation.