Zhou Yu Fen, Xu Ying, Ding Yan Fei, Yu Xiao Jun, Wu Yun Lin, Chen Ping, Zou Duo Wu
Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
J Dig Dis. 2022 Aug;23(8-9):516-526. doi: 10.1111/1751-2980.13137.
To develop and validate a nomogram for predicting 6-week mortality in patients with liver cirrhosis and acute upper gastrointestinal bleeding (UGIB) and to compare it with other commonly used scoring systems.
This retrospective study included cirrhotic patients with acute UGIB hospitalized between January 2013 and December 2020. Random sampling was used to divide patients into the training (n = 676) and validation cohorts (n = 291) at a 7:3 ratio. Multivariate logistic stepwise regression was used to establish a model for predicting 6-week mortality. Multiple indicators were used to validate the nomogram, including the area under the receiver operating characteristic curve (AUROC), calibration curve, and decision curve analysis (DCA).
In the training cohort, total bilirubin (TBIL) (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.22-2.50), hemoglobin (Hb) (OR 0.97, 95% CI 0.95-0.99), C-reactive protein (OR 2.79, 95% CI 1.30-6.07), prothrombin time (OR 1.17, 95% CI 1.05-1.30), and hepatic encephalopathy (stage I-II: OR 4.15, 95% CI 1.73-9.61; stage III-IV: OR 19.6, 95% CI 5.33-76.8) were identified as independent factors of 6-week mortality. The AUROC of the UGIB-LC score was 0.873 (95% CI 0.820-0.927), which was higher than that of the Child-Pugh score (0.781), model for end-stage liver disease score (0.766), and neutrophil-to-lymphocyte ratio (0.716).
The UGIB-LC score is useful for predicting 6-week mortality in patients with liver cirrhosis and acute UGIB, which is superior to the other three scoring systems.
开发并验证一种用于预测肝硬化合并急性上消化道出血（UGIB）患者6周死亡率的列线图，并将其与其他常用评分系统进行比较。
这项回顾性研究纳入了2013年1月至2020年12月期间因急性UGIB住院的肝硬化患者。采用随机抽样的方法，按照7:3的比例将患者分为训练队列（n = 676）和验证队列（n = 291）。采用多因素逻辑逐步回归建立预测6周死亡率的模型。使用多个指标对列线图进行验证，包括受试者操作特征曲线下面积（AUROC）、校准曲线和决策曲线分析（DCA）。
在训练队列中，总胆红素（TBIL）（比值比[OR] 1.75，95%置信区间[CI] 1.22 - 2.50）、血红蛋白（Hb）（OR 0.97，95% CI 0.95 - 0.99）、C反应蛋白（OR 2.79，95% CI 1.30 - 6.07）、凝血酶原时间（OR 1.17，95% CI 1.05 - 1.30）以及肝性脑病（I - II期：OR 4.15，95% CI 1.73 - 9.61；III - IV期：OR 19.6，95% CI 5.33 - 76.8）被确定为6周死亡率的独立因素。UGIB - LC评分的AUROC为0.873（95% CI 0.820 - 0.927），高于Child - Pugh评分（0.781）、终末期肝病模型评分（0.766）和中性粒细胞与淋巴细胞比值（0.716）。
UGIB - LC评分有助于预测肝硬化合并急性UGIB患者的6周死亡率，优于其他三种评分系统。
