临床肝胆病杂志2024，Vol.40Issue(8)：1605-1611,7.DOI:10.12449/JCH240816
肝硬化食管胃底静脉曲张破裂出血患者经颈静脉肝内门体分流术后发生显性肝性脑病的列线图预测模型建立及评价
Establishment and evaluation of a nomogram prediction model for overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis and esophagogastric variceal bleeding
摘要
Abstract
Objective To establish a nomogram prediction model for the development of overt hepatic encephalopathy(OHE)in patients with liver cirrhosis undergoing transjugular intrahepatic portosystemic shunt(TIPS)after esophagogastric variceal bleeding,and to evaluate the predictive ability of the model.Methods This study was conducted among 113 patients with esophagogastric variceal bleeding due to liver cirrhosis who were admitted to The First Affiliated Hospital of Soochow University from January 2020 to December 2022 and underwent TIPS after failed medical or endoscopic therapy.All patients were followed up for 6 months after surgery,and according to the presence or absence of OHE after TIPS,they were divided into OHE group with 32 patients and non-OHE group with 81 patients.Related data were collected from all patients,including clinical data,routine blood test results,serum biochemistry,and coagulation test results.The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups.The multivariate Logistic regression analysis was used to investigate the independent risk factors for the onset of OHE after TIPS,and then a nomogram prediction model was established.The index of concordance(C-index)was calculated and the calibration curve was plotted to evaluate the predictive ability of the model,and the clinical decision curve was plotted to analyze the net clinical benefit of the model.The receiver operating characteristic(ROC)curve was used to validate the predictive ability of the model.Results There were significant differences between the OHE group and the non-OHE group in age,diabetes,Child-Pugh class,ascites,main portal vein diameter before surgery,gamma-glutamyl transpeptidase(GGT)level,prothrombin time,and Freiburg index of post-TIPS survival(FIPS)score(all P<0.05).The multivariate Logistic regression analysis showed that Child-Pugh class(odds ratio[OR]=17.498,95%confidence interval[CI]:2.561-119.548,P=0.004),main portal vein diameter before surgery(OR=1.361,95%CI:1.057-1.752,P=0.017),GGT(OR=1.032,95%CI:1.013-1.052,P=0.001),and FIPS score(OR=2.838,95%CI:1.277-6.311,P=0.010)were independent influencing factors for the development of OHE after TIPS.The nomogram model established based on the above four indicators had a C-index of 0.875,good fitting of the calibration curve,and an area under the ROC curve of 0.875(95%CI:0.799-0.929,P<0.001),and the decision curve analysis showed that the 0.3-0.9 threshold probability model had a good net benefit.Conclusion Child-Pugh class,main portal vein diameter before surgery,GGT,and FIPS score have a certain value in predicting the development of OHE after TIPS in patients with esophagogastric variceal bleeding due to liver cirrhosis,and the nomogram model established based on these indicators can be used to individually predict the onset of OHE after TIPS in patients with esophagogastric variceal bleeding due to liver cirrhosis.关键词
肝硬化/食管和胃静脉曲张/门体分流术,经颈静脉肝内/肝性脑病/列线图Key words
Liver Cirrhosis/Esophageal and Gastric Varices/Portasystemic Shunt,Transjugular Intrahepatic/Hepatic Encephalopathy/Nomograms引用本文复制引用
李欣忆,李娇娇,孙蔚..肝硬化食管胃底静脉曲张破裂出血患者经颈静脉肝内门体分流术后发生显性肝性脑病的列线图预测模型建立及评价[J].临床肝胆病杂志,2024,40(8):1605-1611,7.基金项目
"十三五"国家科技重大专项(2017ZX10203201002-002) （2017ZX10203201002-002）
苏州市卫生青年骨干人才"全国导师制"培训项目(20190013990009) （20190013990009）
天晴肝病研究基金(TQGB20210134)National Major Science and Technology Special Project of the 13th Five-Year Plan Period(2017ZX10203201002-002) （TQGB20210134）
Suzhou Health Youth Backbone Talent"National Tutorial System"Training Project(20190013990009) （20190013990009）
Tianqing Liver Disease Research Foundation(TQGB20210134) （TQGB20210134）
