Abstract
Background
Early rebleeding is a significant complication of endoscopic treatment for esophagogastric variceal hemorrhage (EGVH). However, a reliable predictive model is currently lacking.
Aims
To identify risk factors for rebleeding within 6 weeks and establish a nomogram for predicting early rebleeding after endoscopic treatment of EVGH.
Methods
Demographic 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).
Results
Early 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.
Conclusions
Compared 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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Abbreviations
- ALBIscore:
-
Albumin-bilirubin score
- ALT:
-
Alanine aminotransferase
- AST:
-
Aspartate aminotransferase
- AUC:
-
Area under the ROC curve
- BROT:
-
Balloon-occluded retrograde transvenous obliteration
- DCA:
-
Decision curve analysis
- EBL:
-
Endoscopic band ligation
- EGVH:
-
Esophagogastric variceal hemorrhage
- EVH:
-
Esophageal variceal hemorrhage
- GOV1:
-
Type 1 gastroesophageal varices
- GOV2:
-
Type 2 gastroesophageal varices
- GVH:
-
Gastric variceal hemorrhage
- HVPG:
-
Hepatic venous pressure gradient
- IGV1:
-
Type 1 isolated gastric varices
- INR:
-
International normalized ratio
- IQR:
-
Interquartile range
- LASSO:
-
Least absolute shrinkage and selection operator
- MELD score:
-
Model for end-stage liver disease score
- NSBB:
-
Non-selective beta blocker
- RBC:
-
Red blood cells
- ROC:
-
Receiver-operating characteristic curve
- SBP:
-
Systolic blood pressure
- TIPS:
-
Transjugular intrahepatic portosystemic shunt
- VIF:
-
Variance inflation factor
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Acknowledgments
We thank our colleagues from the Department of Gastroenterology and Endoscopy Center for their strong support and cooperation in this experiment.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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DYQ, XHY, ZZH, ZG contributed to the study idea and design, drafting of the manuscript, and data analysis; CHY and DYQ were involved in data collection; ZZH and XSY contributed to critical revision of the manuscript; All authors approved the final manuscript for submission.
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This study was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Chongqing Medical University. The study adhered to the ethical principles outlined in the Declaration of Helsinki. Considering the retrospective nature of this study, the ethics committee waived the requirement for informed consent. Furthermore, all sensitive patient information underwent a process of anonymization and deidentification prior to analysis.
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Figure S1. Correlation heatmap of predicted variables.
Abbreviations: ALBI score: Albumin-Bilirubin score; ALT: alanine aminotransferase; AST: aspartate aminotransferase; CKD: chronic kidney disease; Cr: creatinine; HCC: hepatocellular carcinoma; HE: hepatic encephalopathy; HR: heart rate; INR: international normalized ratio; MELD score: model for end-stage liver disease score; NET: non-endoscopic treatment; RBC: red blood cells; SBP: systolic blood pressure; WN: white nipple sign or overlying clot. (TIFF 774 kb)
Figure S2. (A) ROC curves for nomogram and other models; (B) Decision curves for nomogram and other models.
Abbreviations: ALBI score: Albumin-Bilirubin score; AUC: area under the ROC curve; CTP score: Child Turcotte Pugh score; ROC: receiver-operating characteristic curve; MELD score: model for end-stage liver disease score. (JPG 201 kb)
Table S1. univariate and multivariate logistic regression analysis of the selected variables.
Abbreviations: CI: confidence interval; HCC: hepatocellular carcinoma; INR: international normalized ratio; OR: odds ratio. (XLSX 10 kb)
Table S2. The VIF of independent predictors included in the nomogram.
Abbreviations: HCC: hepatocellular carcinoma; INR: international normalized ratio; VIF: variance inflation factor. (XLSX 10 kb)
Table S3. The TRIPOD Checklist of the study.
(DOCX 25 kb)
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Dong, Y., Xu, H., Zhang, Z. et al. A Novel Nomogram for Predicting Early Rebleeding After Endoscopic Treatment of Esophagogastric Variceal Hemorrhage. Dig Dis Sci 69, 1852–1862 (2024). https://doi.org/10.1007/s10620-024-08382-0
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DOI: https://doi.org/10.1007/s10620-024-08382-0