Duan Yuxin, Sui Weifan, Cai Zefeng, Xia Yimao, Li Jianyun, Fu Jianhua
Department of Interventional Radiology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China.
Front Med (Lausanne). 2025 May 15;12:1582008. doi: 10.3389/fmed.2025.1582008. eCollection 2025.
Hemoptysis is a life-threatening manifestation frequently observed in patients with cystic bronchiectasis (CB), a radiologically defined subtype of bronchiectasis. Bronchial artery embolization (BAE) is widely employed as an effective interventional therapy for controlling hemoptysis. Despite its clinical utility, the risk of recurrence remains high, particularly in patients with CB. Currently, no reliable predictive model specifically targeting CB-related hemoptysis recurrence following BAE has been established, highlighting the need for a tailored prognostic tool in this population.
This study aimed to develop and validate a model to predict the recurrence of hemoptysis in CB patients following BAE, enabling individualized clinical management and prevention strategies.
A retrospective study was conducted on 111 CB patients who underwent BAE between January 2015 and June 2020. Clinical, radiological, and laboratory data were collected for analysis. Least absolute shrinkage and selection operator (LASSO) regression was applied to identify relevant predictive variables, followed by multivariable Cox proportional hazards regression to determine independent prognostic factors. Based on these predictors, a nomogram was constructed. Its performance was assessed using the concordance index (C-index), receiver operating characteristic (ROC) curves, area under the curve (AUC), calibration plots, and decision curve analysis (DCA).
Five independent predictors were identified: history of hemoptysis (HR = 3.42, 95% CI: 1.64-7.12, = 0.001), diabetes (HR = 15.0, 95% CI: 4.69-48.1, < 0.001), pleural thickening (HR = 3.78, 95% CI: 1.07-13.4, = 0.039), prolonged hospitalization (HR = 1.99, 95% CI: 1.08-3.67, = 0.028), and positive sputum culture (HR = 2.29, 95% CI: 1.26-4.19, = 0.007). The nomogram showed good discriminatory ability, with AUCs of 0.778, 0.797, and 0.829 at 1-, 2-, and 3-year follow-ups, respectively. The integrated Brier score was 0.147, reflecting good overall accuracy. Time-dependent AUC and C-index curves further confirmed the model's prognostic robustness. Calibration plots demonstrated close agreement between predicted and observed recurrence, and decision curve analysis indicated favorable clinical utility. Recurrence-free time was significantly shorter in the high-risk group ( < 0.0001).
The nomogram is a reliable tool for predicting hemoptysis recurrence in CB patients after BAE. It facilitates early identification of high-risk patients, enabling timely, targeted interventions and improved outcomes.
咯血是囊性支气管扩张（CB）患者中常见的危及生命的表现，CB是一种影像学定义的支气管扩张亚型。支气管动脉栓塞术（BAE）被广泛用作控制咯血的有效介入治疗方法。尽管其具有临床实用性，但复发风险仍然很高，尤其是在CB患者中。目前，尚未建立专门针对BAE术后CB相关咯血复发的可靠预测模型，这凸显了针对该人群制定个性化预后工具的必要性。
本研究旨在开发并验证一个模型，以预测CB患者BAE术后咯血的复发情况，从而实现个性化的临床管理和预防策略。
对2015年1月至2020年6月期间接受BAE的111例CB患者进行回顾性研究。收集临床、放射学和实验室数据进行分析。应用最小绝对收缩和选择算子（LASSO）回归来识别相关预测变量，随后进行多变量Cox比例风险回归以确定独立的预后因素。基于这些预测因素构建了列线图。使用一致性指数（C指数）、受试者工作特征（ROC）曲线、曲线下面积（AUC）、校准图和决策曲线分析（DCA）评估其性能。
确定了五个独立预测因素：咯血病史（HR = 3.42，95%CI：1.64 - 7.12，P = 0.001）、糖尿病（HR = 15.0，95%CI：4.69 - 48.1，P < 0.001）、胸膜增厚（HR = 3.78，95%CI：1.07 - 13.4，P = 0.039）、住院时间延长（HR = 1.99，95%CI：1.08 - 3.67，P = 0.028）和痰培养阳性（HR = 2.29，95%CI：1.26 - 4.19，P = 0.007）。列线图显示出良好的区分能力，在1年、2年和3年随访时的AUC分别为0.778、0.797和0.829。综合Brier评分为0.147，反映出总体准确性良好。时间依赖性AUC和C指数曲线进一步证实了该模型的预后稳健性。校准图显示预测复发与观察到的复发之间高度一致，决策曲线分析表明具有良好的临床实用性。高危组的无复发生存时间明显更短（P < 0.0001）。
列线图是预测CB患者BAE术后咯血复发情况的可靠工具。它有助于早期识别高危患者，从而能够及时进行有针对性的干预并改善预后。
