Zhang Shuo, Ji Bing, Zhong Xuan, Zhong Lan, Yang Li, Yang Changqing
Department of Gastroenterology and Hepatology, School of Medicine, Shanghai Tongji Hospital, Tongji University, Shanghai, China.
Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Front Med (Lausanne). 2022 Jun 3;9:887995. doi: 10.3389/fmed.2022.887995. eCollection 2022.
Portal vein thrombosis (PVT) would exert a further increase in resistance to portal blood flow, resulting in worsening portal hypertension and poor outcome. This study aimed to identify risk factors and develop an clinically applicable dynamic nomogram predicting the occurrence of PVT in cirrhotic patients during primary prophylaxis for variveal hemorrhage (VH).
The multi-center retrospective study enrolled cirrhotic patients with high-risk varices, which were further divided into training and validation cohorts for 3 years follow-up. A dynamic nomogram based on the Cox proportional hazard regression model was developed with the cutoff value calculated by X-title analysis. The performance of the nomogram was evaluated with Harrell's concordance index (C-index), calibration curve and decision curve analysis.
91 (34.0%) of the whole cohort were diagnosed with PVT during 3-year follow-up. Variables including carvedilol ( < 0.001), low portal vein velocity ( < 0.001), increased size of esophageal varices ( = 0.005), and high HbA1c ( < 0.001) and procalcitonin ( = 0.015) were identified to be independently associated with PVT, which were further incorporated into the dynamic nomogram with optimal cutoff (8.8 and 14.6) for risk-stratification. The C-indexes (0.894 of internal validation and 0.892 of external validation) and calibration curves demonstrated ideal discrimination and calibration. The thresholds for more reasonable application of the nomogram were 0-0.27, 0-0.66, and 0.04-1.00 at 1, 2, and 3-year, respectively.
The dynamic nomogram could be accurately and reliably used for clinical risk-stratification of PVT in cirrhotic patients during primary prophylaxis for VH.
门静脉血栓形成（PVT）会进一步增加门静脉血流阻力，导致门静脉高压恶化及预后不良。本研究旨在确定危险因素，并开发一种临床适用的动态列线图，以预测肝硬化患者在原发性预防静脉曲张出血（VH）期间发生PVT的情况。
这项多中心回顾性研究纳入了高危静脉曲张的肝硬化患者，将其进一步分为训练队列和验证队列，进行3年随访。基于Cox比例风险回归模型开发了动态列线图，并通过X-tile分析计算截断值。使用Harrell一致性指数（C指数）、校准曲线和决策曲线分析评估列线图的性能。
在3年随访期间，整个队列中有91例（34.0%）被诊断为PVT。包括卡维地洛（<0.001）、门静脉流速低（<0.001）、食管静脉曲张大小增加（=0.005）、高糖化血红蛋白（<0.001）和降钙素原（=0.015）等变量被确定与PVT独立相关，并进一步纳入动态列线图，以进行风险分层的最佳截断值（8.8和14.6）。C指数（内部验证为0.894，外部验证为0.892）和校准曲线显示出理想的区分度和校准度。列线图更合理应用的阈值在1年、2年和3年分别为0 - 0.27、0 - 0.66和0.04 - 1.00。
动态列线图可准确、可靠地用于肝硬化患者在原发性预防VH期间PVT的临床风险分层。
