A Novel Nomogram for Predicting Early Rebleeding After Endoscopic Treatment of Esophagogastric Variceal Hemorrhage

作者全名："Dong, Yongqi; Xu, Hongyan; Zhang, Zhihuan; Zhou, Zhihang; Zhao, Gang; Cao, Haiyan; Xiao, Shiyong"

作者地址："[Dong, Yongqi; Zhao, Gang] Wushan Cty Peoples Hosp Chongqing, Dept Gastroenterol, 168,Guangdongxi Rd, Chongqing 404700, Peoples R China; [Xu, Hongyan] Chongqing Med Univ, Affiliated Hosp 2, Dept Infect Dis, 76,Linjiang Rd, Chongqing 400010, Peoples R China; [Zhang, Zhihuan] Chongqing Med Univ, Affiliated Hosp 2, Dept Rheumatol & Immunol, 76,Linjiang Rd, Chongqing 400010, Peoples R China; [Zhou, Zhihang] Chongqing Med Univ, Affiliated Hosp 2, Dept Gastroenterol, 76,Linjiang Rd, Chongqing 400010, Peoples R China; [Cao, Haiyan] Chengdu Second Peoples Hosp, Dept Gastroenterol, 10, Yunnan Rd, Chengdu 610017, Peoples R China; [Xiao, Shiyong] Wushan Cty Peoples Hosp Chongqing, Dept Clin Nutr, 168,Guangdongxi Rd, Chongqing 404700, Peoples R China"

通信作者："Xiao, SY (通讯作者)，Wushan Cty Peoples Hosp Chongqing, Dept Clin Nutr, 168,Guangdongxi Rd, Chongqing 404700, Peoples R China."

来源：DIGESTIVE DISEASES AND SCIENCES

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001190064900001

JCR分区：Q2

影响因子：2.5

年份：2024

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期号：　

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文献类型：Article; Early Access

关键词：Esophagogastric variceal hemorrhage; Endoscopy; Nomogram; Cirrhosis; Rebleeding

摘要："BackgroundEarly rebleeding is a significant complication of endoscopic treatment for esophagogastric variceal hemorrhage (EGVH). However, a reliable predictive model is currently lacking.AimsTo identify risk factors for rebleeding within 6 weeks and establish a nomogram for predicting early rebleeding after endoscopic treatment of EVGH.MethodsDemographic information, comorbidities, preoperative evaluation, endoscopic features, and laboratory tests were collected from 119 patients who were first endoscopic treatment for EGVH. Independent risk factors for early rebleeding were determined through least absolute shrinkage and selection operator logistic regression. The discrimination, calibration, and clinical utility of the nomogram were assessed and compared with the model for end-stage liver disease (MELD), Child-Pugh, and albumin-bilirubin (ALBI) scores using receiver-operating characteristic (ROC) curves, calibration plots, and decision curve analyses (DCA).ResultsEarly rebleeding occurred in 39 patients (32.8%) within 6 weeks after endoscopic treatment. Independent early rebleeding factors included gastric variceal hemorrhage (GVH), concomitant hepatocellular carcinoma (HCC), international normalized ratio (INR), and creatinine. The nomogram demonstrated exceptional calibration and discrimination capability. The area under the curve for the nomogram was 0.758 (95% CI 0.668-0.848), and it was validated at 0.71 through cross-validation and bootstrapping validation. The DCA and ROC curves demonstrated that the nomogram outperformed the MELD, Child-Pugh, and ALBI scores.ConclusionsCompared with existing prediction scores, the nomogram demonstrated superior discrimination, calibration, and clinical applicability for predicting rebleeding in patients with EGVH after endoscopic treatment. Therefore, it may assist clinicians in the early implementation of aggressive treatment and follow-up."

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