预测门静脉高压出血患者经颈静脉肝内门体分流术后生存情况的列线图
Nomogram for predicting survival after transjugular intrahepatic portosystemic shunt in portal hypertension patients with bleeding.
作者信息
Wang Zhi-Bin, Zhu Bing, Meng Ming-Ming, Wu Yi-Fan, Zhang Yu, Li Dong-Ze, Tian Hua, Wang Fu-Chuan, Lv Yi-Fan, Ye Qiu-Xia, Liu Fu-Quan
机构信息
Center for Minimally Invasive Treatment of Liver Diseases, Beijing Shijitan Hospital, Capital Medical University, Beijing 100080, China.
Center for Diagnosis and Treatment of Hepatic Vascular Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, China.
出版信息
World J Gastrointest Surg. 2025 Apr 27;17(4):104884. doi: 10.4240/wjgs.v17.i4.104884.
BACKGROUND
Portal hypertension (PHT) is a life-threatening complication of cirrhosis, often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt (TIPS). While TIPS effectively reduces portal pressure, predicting long-term survival remains challenging due to the multifactorial nature of patient outcomes. Accurate survival prediction tools are lacking, and existing models often omit critical factors such as portal vein diameter. This study aimed to develop and validate a nomogram incorporating key clinical and biochemical variables to predict 1-year and 2-year survival following TIPS in PHT patients. We hypothesized that this model would provide improved risk stratification and guide clinical decisions.
AIM
To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.
METHODS
This retrospective cohort study included 848 TIPS-treated PHT patients with gastrointestinal bleeding from two tertiary hospitals (2013-2021). Mortality was the primary endpoint. Predictive variables were selected using least absolute shrinkage and selection operator regression, and a nomogram was developed with Cox regression to predict 1-year and 2-year survival. Model performance was evaluated through receiver operating characteristic curves, calibration plots, and decision curve analysis.
RESULTS
The mean age of the included (848) patients was 53.00 years ± 12.51, where 69.58% were men. Results showed that portal vein diameter, serum creatinine, potassium, and alpha-fetoprotein were the independent predictors of post-TIPS survival. Besides, the model showed strong discriminatory ability (C-index, 0.816 in the training set; 0.827 in the validation set) and good calibration. The area under the curve for 1-year and 2-year survival in the training set were 0.890 [95% confidence interval (CI): 0.802-0.948] and 0.838 (95%CI: 0.803-0.869), respectively. The area under the curve for 1-year and 2-year survival in the validation set were 0.934 (95%CI: 0.815-0.987) and 0.864 (95%CI: 0.811-0.907), respectively.
CONCLUSION
The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHT-induced gastrointestinal bleeding.
背景
门静脉高压（PHT）是肝硬化的一种危及生命的并发症，常导致需要经颈静脉肝内门体分流术（TIPS）治疗的胃肠道出血。虽然TIPS能有效降低门静脉压力，但由于患者预后的多因素性质，预测长期生存率仍具有挑战性。目前缺乏准确的生存预测工具，现有模型往往忽略了诸如门静脉直径等关键因素。本研究旨在开发并验证一种包含关键临床和生化变量的列线图，以预测PHT患者TIPS术后1年和2年的生存率。我们假设该模型将提供更好的风险分层并指导临床决策。
目的
开发并验证一种用于预测PHT患者TIPS术后1年和2年生存率的列线图。
方法
这项回顾性队列研究纳入了来自两家三级医院（2013 - 2021年）的848例因胃肠道出血接受TIPS治疗的PHT患者。死亡率是主要终点。使用最小绝对收缩和选择算子回归选择预测变量，并通过Cox回归开发列线图以预测1年和2年生存率。通过受试者工作特征曲线、校准图和决策曲线分析评估模型性能。
结果
纳入的848例患者的平均年龄为53.00岁±12.51岁，其中69.58%为男性。结果显示门静脉直径、血清肌酐、钾和甲胎蛋白是TIPS术后生存的独立预测因素。此外，该模型显示出较强的区分能力（训练集中C指数为0.816；验证集中为0.827）和良好的校准。训练集中1年和2年生存率的曲线下面积分别为0.890[95%置信区间（CI）：0.802 - 0.948]和0.838（95%CI：0.803 - 0.869）。验证集中1年和2年生存率的曲线下面积分别为0.934（95%CI：0.815 - 0.987）和0.864（9,5%CI：0.811 - 0.907）。
结论
所开发的列线图能够可靠地预测因PHT引起的胃肠道出血而接受TIPS治疗的患者的1年和2年生存率。
Zotero 插件