Development and validation of a nomogram for esophagogastric variceal bleeding in liver cirrhosis: A cohort study in 1099 cases

被引:19
作者
Liu, Chun Hua [1 ]
Liu, Shuang [2 ]
Zhao, Yong Bing [2 ]
Liao, Yu [2 ]
Zhao, Guo Che [2 ]
Lin, Hui [2 ]
Yang, Shi Ming [2 ]
Xu, Zheng Guo [2 ]
Wu, Hao [3 ]
Liu, En [2 ]
机构
[1] Army Med Univ, Grad Sch, Chongqing, Peoples R China
[2] Army Med Univ, Dept Gastroenterol, Affiliated Hosp 2, 183 Xinqiao St, Chongqing 400037, Peoples R China
[3] Army Med Univ, Fac Off, Affiliated Hosp 2, 183 Xinqiao St, Chongqing 400037, Peoples R China
关键词
cirrhosis; clinical decision making; esophagogastric varices; gastrointestinal bleeding; nomogram; SIGNIFICANT PORTAL-HYPERTENSION; COMPENSATED CIRRHOSIS; UK GUIDELINES; DIAGNOSIS; RISK; MANAGEMENT; HEMORRHAGE; PRESSURE; ASSOCIATION; ULTRASOUND;
D O I
10.1111/1751-2980.13145
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
ObjectivesEsophagogastric variceal bleeding (EVB) is a catastrophic complication of decompensated liver cirrhosis. We aimed to establish a nomogram based on noninvasive clinical and imaging variables to predict the risk of EVB. MethodsThe cut-off value of each variable was determined through univariate regression analysis. The least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression analyses were used to determine the risk factors and establish predictive models. The nomogram was established and validated using the calibration discrimination across different groups. ResultsSix indicators, including platelet count, hemoglobin, albumin to globulin ratio, fasting blood glucose, serum chloride, and computed tomography portal vein diameter (CTPD), were found to be related to the risk of EVB. Two models, with or without CTPD, were established and compared. Model 1 with CTPD had better discrimination than model 2 with C-index of 0.893 (95% confidence interval [CI] 0.872-0.915) and 0.862 (95% CI 0.837-0.887) in the primary cohort, respectively (Z = 2.027, P = 0.043). While the C-index of the two models in the validation cohort was 0.878 (95% CI 0.838-0.919) and 0.810 (95% CI 0.757-0.863). Moreover, the clinical decision analysis curve and clinical impact curve showed that these models might confer a significant net benefit on patients and provide a reference threshold for clinicians. ConclusionA nomogram using routine clinical indicators was established to predict the risk of EVB in patients with liver cirrhosis, which was verified in an independent cohort and demonstrated a great consistency.
引用
收藏
页码:597 / 609
页数:13
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