Department of Hepatology, The Second People's Hospital of Fuyang City, Fuyang, Anhui Province, P.R. of China.
Eur J Gastroenterol Hepatol. 2024 Jun 1;36(6):758-765. doi: 10.1097/MEG.0000000000002750. Epub 2024 Apr 24.
Esophageal variceal (EV) hemorrhage is a life-threatening consequence of portal hypertension in hepatitis B virus (HBV) -induced cirrhotic patients. Screening upper endoscopy and endoscopic variceal ligation to find EVs for treatment have complications, contraindications, and high costs. We sought to identify the nomogram models (NMs) as alternative predictions for the risk of EV hemorrhage.
In this case-control study, we retrospectively analyzed 241 HBV-induced liver cirrhotic patients treated for EVs at the Second People's Hospital of Fuyang City, China from January 2021 to April 2023. We applied univariate analysis and multivariate logistic regression to assess the accuracy of various NMs in EV hemorrhage. The area under the curve (AUC) and calibration curves of the receiver's operating characteristics were used to evaluate the predictive accuracy of the nomogram. Decision curve analysis (DCA) was used to determine the clinically relevant of nomograms.
In the prediction group, multivariate logistic regression analysis identified platelet distribution and spleen length as independent risk factors for EVs. We applied NMs as the independent risk factors to predict EVs risk. The NMs fit well with the calibration curve and have good discrimination ability. The AUC and DCA demonstrated that NMs with a good net benefit. The above results were validated in the validation cohort.
Our non-invasive NMs based on the platelet distribution width and spleen length may be used to predict EV hemorrhage in HBV-induced cirrhotic patients. NMs can help clinicians to increase diagnostic performance leading to improved treatment measures.
乙型肝炎病毒（HBV）诱导的肝硬化患者门静脉高压会导致食管静脉曲张（EV）出血，这是一种危及生命的后果。筛查上消化道内镜和内镜下食管静脉曲张结扎术以发现 EV 并进行治疗存在并发症、禁忌症和高成本等问题。我们试图确定列线图模型（NMs）作为 EV 出血风险的替代预测指标。
在这项病例对照研究中，我们回顾性分析了 2021 年 1 月至 2023 年 4 月在中国阜阳市第二人民医院接受 EV 治疗的 241 例 HBV 诱导的肝硬化患者。我们应用单因素分析和多变量逻辑回归评估了各种 NMs 在 EV 出血中的准确性。曲线下面积（AUC）和接收器工作特征曲线的校准曲线用于评估列线图的预测准确性。决策曲线分析（DCA）用于确定列线图的临床相关性。
在预测组中，多变量逻辑回归分析确定血小板分布宽度和脾脏长度是 EV 的独立危险因素。我们应用 NMs 作为独立危险因素来预测 EV 风险。NMs 与校准曲线拟合良好，具有良好的区分能力。AUC 和 DCA 表明 NMs 具有良好的净获益。上述结果在验证队列中得到了验证。
我们基于血小板分布宽度和脾脏长度的非侵入性 NMs 可能用于预测 HBV 诱导的肝硬化患者的 EV 出血。NMs 可以帮助临床医生提高诊断性能，从而采取改进的治疗措施。
