Zhongguo quanke yixue (Dec 2023)
Risk Factors Analysis and Risk Prediction Model Establishment for Rebleeding Events within 3 Years after Endoscopic Treatment of Gastroesophageal Varices in Liver Cirrhosis Patients
Abstract
Background Patients with liver cirrhosis complicated by gastroesophageal variceal and rupture hemorrhage have a certain probability of rebleeding events after endoscopic treatment, and the bleeding volume of rebleeding events is greater with higher risk, which seriously affects the survival rates of patients. Objective To investigate the independent risk factors of rebleeding events within 3 years after endoscopic treatment in cirrhotic patients with gastroesophageal variceal hemorrhage, construct a nomogram risk prediction model and validate it internally. Methods Four hundred and three patients who underwent endoscopic treatment for liver cirrhosis associated gastroesophageal varices at the Tangdu Hospital and Xijing Hospital, Air Force Medical University from 2011-2022 were retrospectively collected and divided into the rebleeding group (n=252) and control group (n=151) based on the presence of rebleeding within 3 years. The general data and auxiliary examination results of the patients between both groups were compared, and the statistically significant factors were included in the multivariate Logistic regression analysis to analyze the independent risk factors. These data were then input into the R language software to construct a nomogram risk prediction model by using a specific program package. Results Multivariate Logistic regression analysis showed that smoking〔OR=2.499, 95%CI (1.232, 5.066), P=0.011〕, portal vein internal diameter〔OR=1.047, 95%CI (1.028, 1.066), P<0.001〕, serum sodium concentration〔OR=0.649, 95%CI (0.562, 0.750), P<0.001〕 and endoscopic red sign〔OR=3.023, 95%CI (1.341, 6.814), P=0.008〕 were influencing factors of rebleeding events within 3 years after endoscopic treatment in cirrhotic patients with gastroesophageal variceal hemorrhage. A nomogram prediction model for rebleeding within 3 years after endoscopic treatment was subsequently constructed, and the area under the receiver operating characteristic (ROC) curve was 0.900〔95%CI (0.876, 0.929) 〕 with sensitivity and specificity of 0.927 and 0.750, respectively. Conclusion Serum sodium level, positive endoscopic red sign, smoking, and enlarged portal vein internal diameter are independent influencing factors for rebleeding events within three years after endoscopic treatment in cirrhotic patients with gastroesophageal variceal hemorrhage. The nomogram prediction model exhibited a good fit with an area under the ROC curve of 0.900, showing its high-quality predictive value.
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