Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Front Cell Infect Microbiol. 2023 Jan 17;13:1062172. doi: 10.3389/fcimb.2023.1062172. eCollection 2023.
Variceal hemorrhage (VH) is a life-threatening complication of cirrhosis. An accurate VH risk evaluation is critical to determine appropriate prevention strategies. We aimed to develop an individualized prediction model to predict the risk of first VH in hepatitis B virus (HBV)-related cirrhotic patients.
A nomogram was developed based on a retrospective analysis of 527 consecutive HBV-related cirrhotic patients with gastroesophageal varices (GEVs). The nomogram evaluation was performed using the area under the receiver operating characteristic curve (AUC), concordance index (C-index), calibration plot, and decision curve analysis (DCA). The results were verified using an external cohort (n = 187).
We developed a nomogram based on clinical and endoscopic features, including the size of varices, red wale marks, ascites, spleen thickness, γ-glutamyltransferase, and hematocrit. The C-index of the nomogram in the derivation and validation cohort was 0.806 and 0.820, respectively, and the calibration plot fitted well. Compared with those of the North Italian Endoscopic Club (NIEC) and revised NIEC indexes, the AUC (derivation cohort: 0.822 vs. 0.653 vs. 0.713; validation cohort: 0.846 vs. 0.685 vs. 0.747) and DCA curves of this nomogram were better. Further, based on the risk scores, patients were classified into low-, medium-, and high-risk groups, and significant differences were noted in VH incidence among the three risk groups (0.001 for each cohort).
An effective individualized nomogram to predict the risk of first VH in HBV-related GEV patients was established, which can assist clinicians in developing more appropriate prevention strategies.
静脉曲张出血（VH）是肝硬化的一种危及生命的并发症。准确评估 VH 风险对于确定适当的预防策略至关重要。我们旨在开发一种个体化预测模型，以预测乙型肝炎病毒（HBV）相关肝硬化患者首次 VH 的风险。
基于对 527 例连续的乙型肝炎病毒相关肝硬化伴胃食管静脉曲张（GEV）患者的回顾性分析，制定了一个列线图。使用接受者操作特征曲线（ROC）下面积（AUC）、一致性指数（C-index）、校准图和决策曲线分析（DCA）对列线图评估进行。使用外部队列（n=187）进行验证。
我们基于临床和内镜特征制定了一个列线图，包括静脉曲张的大小、红色征、腹水、脾脏厚度、γ-谷氨酰转移酶和红细胞压积。该列线图在推导和验证队列中的 C-index 分别为 0.806 和 0.820，校准图拟合良好。与北意大利内镜俱乐部（NIEC）和修订的 NIEC 指数相比，该列线图的 AUC（推导队列：0.822 与 0.653 与 0.713；验证队列：0.846 与 0.685 与 0.747）和 DCA 曲线更好。此外，根据风险评分，患者被分为低、中、高危组，三组 VH 发生率差异有统计学意义（每个队列均为 0.001）。
建立了一种有效的个体化列线图，用于预测乙型肝炎病毒相关 GEV 患者首次 VH 的风险，有助于临床医生制定更合适的预防策略。
