老年肝硬化食管胃静脉曲张出血患者内镜治疗后再出血预测模型的建立与验证

Establishment and validation of a predictive model for rebleeding after endoscopic treatment in elderly patients with liver cir-rhosis and esophagogastric variceal bleeding

中文关键词: 老年  肝硬化  食管胃静脉曲张破裂出血  再出血  预测模型

英文关键词: elderly  liver cirrhosis  esophagogastric variceal bleeding  rebleeding  predictive model

中文摘要:

      目的 基于纵向队列数据,构建并验证老年肝硬化食管胃静脉曲张出血(EGVB)患者内镜治疗后再出血的预测模型.方法 回顾性收集2015年4月-2023年4月于上海中医药大学附属曙光医院因肝硬化EGVB接受治疗的182例老年患者的资料,使用LASSO回归筛选变量,构建Cox成比例风险模型,并评估模型性能,使用Bootstrap法进行内部验证.结果 LASSO回归筛选得到的再出血危险因素包括腹水(HR=3.96)、细菌感染(HR=2.66)和门静脉血栓(HR=2.46)、白细胞计数(HR=1.12);保护因素为D-二聚体升高(HR=0.92)和白蛋白水平(HR=0.87).模型的12个月再出血预测一致性指数为0.818,Brier指数为0.115,区分度和准确率较好,优于Child-Pugh评分和MELD评分,3个月、6个月时同样表现出良好的区分度和准确率.内部验证亦显示出良好预测能力.结论 本研究建立针对老年肝硬化EGVB患者内镜治疗后再出血的预测模型,对不同时期再出血事件可能有较好的预测能力.

英文摘要:

      Objective To develop and validate a predictive model for rebleeding after endoscopic treatment in elderly patients with liver cirrhosis and esophagogastric variceal bleeding(EGVB)based on longitudinal cohort data.Methods The clinical data of 182 elderly patients with cirrhotic EGVB treated in Shuguang Hospital Affiliated to Shanghai University of Tradi-tional Chinese Medicine from April 2015 to April 2023 were retrospectively collected.LASSO regression was used to screen variables.A Cox proportional hazards model was constructed and its performance was evaluated.Internal validation was con-ducted via Bootstrap method.Results LASSO regression identified the following risk factors for rebleeding:ascites(HR=3.96),bacterial infection(HR=2.66),portal vein thrombosis(HR=2.46),and white blood cell count(HR=1.12).Pro-tective factors included elevated D-dimer(HR=0.92)and albumin levels(HR=0.87).The 12-month rebleeding prediction consistency index of the model was 0.818,and the Brier index was 0.115.The discrimination and accuracy were good,which was superior to the Child-Pugh score and MELD score.It also showed good discrimination and accuracy at 3 months and 6 months.Internal validation also showed good predictive ability.Conclusion This study established a predictive model for re-bleeding in elderly patients with cirrhotic EGVB after endoscopic treatment.It may have a good predictive ability for rebleeding events at different periods.