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建立并验证用于预测肝硬化住院患者门静脉血栓形成的列线图。

Establishment and verification a nomogram for predicting portal vein thrombosis presence among admitted cirrhotic patients.

作者信息

Liu Guang-Hua, Lei Ping, Liao Chu-Shu, Li Jing, Long Jiang-Wen, Huan Xi-Sha, Chen Jie

机构信息

Department of Blood Transfusion, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.

Laboratory of Hematology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.

出版信息

Front Med (Lausanne). 2023 Jan 6;9:1021899. doi: 10.3389/fmed.2022.1021899. eCollection 2022.

Abstract

BACKGROUND

Portal vein thrombosis (PVT) is an increasingly recognized complication of cirrhosis and possibly associated with mortality. This study aims to evaluate provoking factors for PVT, then establish a concise and efficient nomogram for predicting PVT presence among admitted cirrhotic patients.

MATERIALS AND METHODS

All cirrhotic patients admitted in Hunan Provincial People's Hospital between January 2010 and September 2020 were retrospectively reviewed, the clinical and laboratory data were collected. Multivariate logistic regression analysis and the least absolute shrinkage and selection operator regression method were used for screening the independent predictors and constructing the nomogram. The calibration curve was plotted to evaluate the consistent degree between observed outcomes and predicted probabilities. The area under the receiver operating characteristics curve was used to assess the discriminant performance. The decision curve analysis (DCA) was carried out to evaluate the benefits of nomogram.

RESULTS

A total of 4,479 patients with cirrhosis were enrolled and 281 patients were identified with PVT. Smoking history, splenomegaly, esophagogastric varices, surgical history, red blood cell transfusion, and D-dimer were independent risk factors for PVT in cirrhosis. A nomogram was established with a good discrimination capacity and predictive efficiency with an the area under the curve (AUC) of 0.704 (95% CI: 0.664-0.745) in the training set and 0.685 (95% CI: 0.615-0.754) in the validation set. DCA suggested the net benefit of nomogram had a superior risk threshold probability.

CONCLUSION

A concise and efficient nomogram was established with good performance, which may aid clinical decision making and guide best treatment measures.

摘要

背景

门静脉血栓形成(PVT)是肝硬化中一种日益被认识到的并发症,可能与死亡率相关。本研究旨在评估PVT的诱发因素,然后建立一个简洁有效的列线图,用于预测肝硬化住院患者中PVT的存在情况。

材料与方法

回顾性分析2010年1月至2020年9月在湖南省人民医院住院的所有肝硬化患者,收集临床和实验室数据。采用多因素logistic回归分析和最小绝对收缩和选择算子回归方法筛选独立预测因素并构建列线图。绘制校准曲线以评估观察结果与预测概率之间的一致程度。采用受试者操作特征曲线下面积评估判别性能。进行决策曲线分析(DCA)以评估列线图的益处。

结果

共纳入4479例肝硬化患者,其中281例被诊断为PVT。吸烟史、脾肿大、食管胃静脉曲张、手术史、红细胞输血和D-二聚体是肝硬化患者发生PVT的独立危险因素。建立了一个列线图,其判别能力和预测效率良好,训练集曲线下面积(AUC)为0.704(95%CI:0.664-0.745),验证集为0.685(95%CI:0.615-0.754)。DCA表明列线图的净效益具有较高的风险阈值概率。

结论

建立了一个性能良好的简洁有效的列线图,可辅助临床决策并指导最佳治疗措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0a45/9852861/149a62967d4a/fmed-09-1021899-g0001.jpg

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