ObjectiveTo construct and validate a nomograph model for portal vein thrombosis(PVT) risk after esophagogastric variceal rupture and bleeding in patients with cirrhosis based on multi-dimensional indicators.
MethodsA total of 448 patients with liver cirrhosis complicated with esophagogastric variceal rupture and bleeding were selected and divided into the study cohort(n=336) and test cohort(n=112) at the ratio of 3:1.The two cohorts were subdivided into the thrombus group and non-thrombus group according to whether PVT occurrence.The main risk factors of PVT in the study cohort after esophagogastric variceal rupture and bleeding in patients with cirrhosis were screened by univariate analysis and multivariate regression analysis, and a nomograph model was constructed using rms package in RStudio software and verified.
ResultsIn the study cohort, 77 cases(22.92%) developed PVT, in which the fastest PVT formation after bleeding took two weeks, 49.35%(38/77) developed PVT within one year, and 79.22%(61/77) combined with PVT within two years.In the test cohort, 26 cases(23.21%) developed PVT, in which the fastest PVT formation after bleeding took 12 days, 50%(13/26) developed PVT within 1 year, and 80.77%(21/26)combined PVT within 2 years.Univariate analysis showed that there were significant differences in Child-Pugh liver function grade, portal vein diameter, platelet count, D-dimer, P-selectin and triacylglycerol between PVT group and non-PVT group(P < 0.05 to P < 0.01).Multivariate logistic regression analysis showed that Child-Pugh liver function grade, portal vein diameter, platelet count, D-dimer, P-selectin and triacylglycerol were the risk factors for PVT after esophagogastric variceal rupture and bleeding in patients with cirrhosis(P < 0.01).ROC curve analysis showed that the area under the curve(AUC) of the risk nomogram prediction model in the study cohort was 0.953(95%CI: 0.931-0.976), the sensitivity was 81.8%, and the specificity was 94.2%.ROC curve analysis showed that the AUC of the risk nomogram prediction model in the test cohort was 0.944(95%CI: 0.904-0.984), the sensitivity was 98.9%, and the specificity was 81.4%.
ConclusionsChild-Pugh liver function grade, portal vein diameter, platelet count, D-dimer, P-selectin and triacylglycerol are the risk factors of PVT in patients with liver cirrhosis complicated with esophagogastric variceal rupture and bleeding.The nomogram prediction model based on the above indicators has good diagnostic performance, and can provide a reference for development of targeted treatment plans in clinic.
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