Zhuhai Interventional Medical Centre, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), No. 79 Kangning Road, Zhuhai, China.
Department of Biostatistics, School of Public Health, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, China.
Eur J Radiol. 2022 Sep;154:110384. doi: 10.1016/j.ejrad.2022.110384. Epub 2022 May 28.
Preoperative prediction of overt hepatic encephalopathy (OHE) should be performed in patients with variceal bleeding treated using the transjugular intrahepatic portosystemic shunt (TIPS) procedure. A reliable prediction tool is therefore required.
Patients with cirrhosis-related variceal bleeding treated using the TIPS procedure were screened at two hospitals. Patients classified as Child-Pugh Class B were identified. The least absolute shrinkage and selection operator method and the backward stepwise selection method were used to screen the clinical and radiological characteristics of participants. Then, models were constructed accordingly to predict OHE. Area under the receiver operating characteristic curves, calibration curves, and decision curves were performed to discover the optimal model. Finally, whether clinical factors influenced the performance of our optimal model was tested.
A total of 191 patients were included (training cohort: 127 cases; validation cohort: 64 cases). Three novel radiological independent risk factors were found. The combined model outperformed the models containing clinical factors or radiological characteristics alone. The areas under the curve for the training and validation cohorts were 0.901 and 0.903, respectively, with satisfactory calibration and decision curves. The Model for End-Stage Liver Disease score, serum sodium, albumin, total bilirubin, and age exhibited limited influence on the performance of the combined model.
These radiological characteristics are also independent risk factors for post-TIPS OHE. Combining clinical factors and radiological characteristics was an effective means of predicting OHE. This study's model could be used for preoperative selection of appropriate patients before the TIPS procedure is performed.
在行经颈静脉肝内门体分流术（TIPS）治疗的静脉曲张出血患者中，应进行显性肝性脑病（OHE）的术前预测。因此，需要一种可靠的预测工具。
在两家医院筛选接受 TIPS 治疗的肝硬化相关静脉曲张出血患者。确定为 Child-Pugh 分级 B 的患者。使用最小绝对收缩和选择算子法和后向逐步选择法筛选参与者的临床和影像学特征。然后，相应地构建模型以预测 OHE。进行受试者工作特征曲线下面积、校准曲线和决策曲线分析，以发现最佳模型。最后，测试临床因素是否影响我们最佳模型的性能。
共纳入 191 例患者（训练队列：127 例；验证队列：64 例）。发现了三个新的影像学独立危险因素。联合模型优于仅包含临床因素或影像学特征的模型。训练队列和验证队列的曲线下面积分别为 0.901 和 0.903，具有良好的校准和决策曲线。终末期肝病模型评分、血清钠、白蛋白、总胆红素和年龄对联合模型的性能影响有限。
这些影像学特征也是 TIPS 后 OHE 的独立危险因素。将临床因素和影像学特征相结合是预测 OHE 的有效手段。本研究的模型可用于 TIPS 术前选择合适的患者。
