Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe East Road, Zhengzhou, 450052, China.
Abdom Radiol (NY). 2023 Jul;48(7):2456-2465. doi: 10.1007/s00261-023-03936-8. Epub 2023 May 9.
To analyze the risk factors and develop a clinical prediction model for early biliary infection (EBI) after percutaneous transhepatic biliary stenting (PTBS) in patients with malignant biliary obstruction (MBO).
The clinical data of 236 patients with MBO treated with PTBS from June 2012 to June 2021 were retrospectively analyzed. Independent risk factors were analyzed by univariate and multivariate logistic regression, and a nomogram model was constructed based on the results. Discrimination, calibration, and clinical usefulness of this model were further assessed.
The technical success rate of PTBS was 100%, and EBI after PTBS was 20.3%. Multivariate logistic regression analysis showed that hilar MBO (P = 0.020), diabetes (P = 0.001), previous surgical or endoscopic intervention (P = 0.007), procedure time > 60 min (P = 0.007), and intraprocedural biliary hemorrhage (P = 0.003) were independent risk factors for EBI after PTBS. A nomogram model was developed to predict the probability of EBI. ROC curves showed good discrimination of the model (area under curve = 0.831). The calibration plot indicated that the predicted probability of EBI by this model was in good agreement with the actual probability of EBI. The DCA curves showed that the net benefit of nomogram-assisted decisions was higher than or equal to the net benefit of treatment for all or none at a wide threshold probability (0-0.8).
The nomogram model based on the above independent risk factors can predict the probability of EBI and model-assisted treatment decisions contribute to improved clinical outcome. Therefore, MBO patients with probability of EBI > 0.20 based on the model should be recommended for perioperative broad-spectrum antibiotics and close monitoring.
分析经皮经肝胆道支架置入术（PTBS）后恶性胆道梗阻（MBO）患者发生早期胆道感染（EBI）的风险因素，并建立临床预测模型。
回顾性分析 2012 年 6 月至 2021 年 6 月 236 例 MBO 患者行 PTBS 的临床资料。采用单因素和多因素 logistic 回归分析独立危险因素，并基于结果构建列线图模型。进一步评估该模型的判别、校准和临床实用性。
PTBS 的技术成功率为 100%，PTBS 后 EBI 的发生率为 20.3%。多因素 logistic 回归分析显示，肝门部 MBO（P=0.020）、糖尿病（P=0.001）、既往外科或内镜干预（P=0.007）、手术时间>60 min（P=0.007）和术中胆道出血（P=0.003）是 PTBS 后 EBI 的独立危险因素。建立了预测 EBI 概率的列线图模型。ROC 曲线显示模型具有良好的判别能力（曲线下面积为 0.831）。校准图表明，该模型预测的 EBI 概率与实际 EBI 概率吻合较好。DCA 曲线表明，在广泛的阈值概率（0-0.8）下，列线图辅助决策的净获益高于或等于全治疗或无治疗的净获益。
基于上述独立危险因素的列线图模型可预测 EBI 的概率，且模型辅助治疗决策有助于改善临床结局。因此，对于基于模型 EBI 概率>0.20 的 MBO 患者，建议围手术期使用广谱抗生素并密切监测。
