Risk factors for myocardial injury in esophagogastric variceal bleeding patients with cirrhosis

Abstract

Objective To explore the risk factors for myocardial injury in esophagogastric variceal bleeding (EGVB) patients with liver cirrhosis during hospitalization. Methods A case-control trial was conducted on 235 EGVB patients admitted to our hospital between May 2021 and July 2022. Their basic information, laboratory results and relevant data during hospitalization were collected. According to their myocardial enzyme profiles during hospitalization, they were divided into myocardial injury group (n=46) and non-myocardial injury group (n=189). Univariate regression analysis and clinical correlation analysis were used to preliminarily screen the risk factors for myocardial injury secondary to EGVB caused by liver cirrhosis. Then, multivariate logistic regression analysis was used to further screen the risk factors. A nomogram was constructed based on the selected risk factors and the occurrence of myocardial injury. Receiver operating characteristic (ROC) curve was plotted to analyze the independent predictive value of these factors alone or combined together. Calibration curve analysis and internal verification were utilized to evaluate the predictive performance of the nomogram model. Subgroup verification was performed in the myocardial infarction group. Results Univariate analysis revealed that statistical differences were observed in age, sex, hypertension, renal disease, underlying diseases, vomiting, leukocytosis, increased alanine aminotransferase (ALT) or aspartate aminotransferase (AST), albumin, red blood cell hematocrit (HCT), international normalized ratio (INR), endoscopy within 6 h after admission, and Child-Pugh (CP) class between the myocardial injury group and the non-myocardial injury group (P<0.01). Multivariate logistic regression analysis showed that age (P=0.014, OR=1.153, 95%CI: 1.030~1.291), underlying diseases (P=0.005, OR=1.122, 95%CI: 1.032~2.437), and albumin (P=0.012, OR=0.449, 95%CI: 0.241~0.837) were independent risk factors for inhospital myocardial injury in EGVB patients with liver cirrhosis. The AUC value of the above indicators combined together for predicting myocardial injury was 0.902. Hosmer-Lemeshow test and calibration curve analysis indicated that the nomogram had good prediction consistency (Chi-square=12.88, P=0.615). Internal verification correctly distinguished 86.4% of verification objects. Subgroup analysis of myocardial injury patients showed that albumin was also an independent risk factor for in-hospital myocardial injury in this population (AUC=0.80). Conclusion Age, underlying diseases, and albumin level are independent risk factors for in-hospital myocardial injury in EGVB patients with liver cirrhosis. Albumin level can be used as an independent risk factor for predicting myocardial infarction. Combination of the above 3 indicators has a high diagnostic value in early identification and prevention of myocardial injury in this patient population.

Keywords

• liver cirrhosis
• esophagogastric variceal bleeding
• myocardial injury
• risk factors