未经证实:静脉曲张破裂出血(VH)是一种危及生命的肝硬化并发症。准确的VH风险评估对于确定适当的预防策略至关重要。我们旨在开发一种个性化的预测模型,以预测乙型肝炎病毒(HBV)相关的肝硬化患者的第一VH的风险。
UNASSIGNED:根据对527例连续HBV相关肝硬化患者胃食管静脉曲张(GEVs)的回顾性分析,开发了列线图。使用接受者工作特征曲线下面积(AUC)进行列线图评估,一致性指数(C指数),校准图,和决策曲线分析(DCA)。使用外部队列(n=187)验证结果。
UNASSIGNED:我们根据临床和内窥镜特征开发了列线图,包括静脉曲张的大小,红色墙痕,腹水,脾脏厚度,γ-谷氨酰转移酶,和血细胞比容.推导和验证队列中的列线图的C指数分别为0.806和0.820,和校准图拟合良好。与北意大利内窥镜俱乐部(NIEC)和修订的NIEC指标相比,AUC(派生队列:0.822vs.0.653vs.0.713;验证队列:0.846vs.0.685vs.0.747)和此列线图的DCA曲线较好。Further,根据风险评分,患者被分类为低,medium-,和高危人群,3个风险组的VH发生率存在显著差异(每个队列P<0.001).
UNASSIGNED:建立了有效的个性化列线图来预测HBV相关GEV患者的首次VH风险,这可以帮助临床医生制定更合适的预防策略。
Variceal hemorrhage (VH) is a life-threatening complication of cirrhosis. An accurate VH risk evaluation is critical to determine appropriate prevention strategies. We aimed to develop an individualized prediction model to predict the risk of first VH in hepatitis B virus (HBV)-related cirrhotic patients.
A nomogram was developed based on a retrospective analysis of 527 consecutive HBV-related cirrhotic patients with gastroesophageal varices (GEVs). The nomogram evaluation was performed using the area under the receiver operating characteristic curve (AUC), concordance index (C-index), calibration plot, and decision curve analysis (DCA). The results were verified using an external cohort (n = 187).
We developed a nomogram based on clinical and endoscopic features, including the size of varices, red wale marks, ascites, spleen thickness, γ-glutamyltransferase, and hematocrit. The C-index of the nomogram in the derivation and validation cohort was 0.806 and 0.820, respectively, and the calibration plot fitted well. Compared with those of the North Italian Endoscopic Club (NIEC) and revised NIEC indexes, the AUC (derivation cohort: 0.822 vs. 0.653 vs. 0.713; validation cohort: 0.846 vs. 0.685 vs. 0.747) and DCA curves of this nomogram were better. Further, based on the risk scores, patients were classified into low-, medium-, and high-risk groups, and significant differences were noted in VH incidence among the three risk groups (P <0.001 for each cohort).
An effective individualized nomogram to predict the risk of first VH in HBV-related GEV patients was established, which can assist clinicians in developing more appropriate prevention strategies.