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Development and validation of a nomogram predicting rebleeding in cirrhotic patients with patent transjugular intrahepatic portosystemic shunt 认领 引用
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作者 Yang-Tian Ren Jun-Yi Wen +4 位作者 Jing-Jing Tu Han Zhang Chuan-Fu Ding Jiang-Qiang Xiao Yu-Zheng Zhuge 《World Journal of Gastroenterology》 SCIE CAS 2026年第23期22-33,共12页
BACKGROUND Even with stent patency following transjugular intrahepatic portosystemic shunt(TIPS)placement,some patients still experience recurrent variceal bleeding.AIM To identify risk factors and develop a predictiv... BACKGROUND Even with stent patency following transjugular intrahepatic portosystemic shunt(TIPS)placement,some patients still experience recurrent variceal bleeding.AIM To identify risk factors and develop a predictive model for rebleeding in patients with patent TIPS stents.METHODS Cirrhotic patients(n=647)undergoing TIPS(2010-2024)were retrospectively analyzed and grouped by rebleeding status.Propensity score matching(1:3)was performed for age,sex,and model for end-stage liver disease score.Independent predictors identified via univariate and multivariate logistic regression were used to construct a nomogram.The model was internally validated using bootstrapping and evaluated via area under the receiver operating characteristic curve(AUC),calibration curves,and decision curve analysis.RESULTS Of the 73 patients with rebleeding following patent TIPS placement,variceal rebleeding was the primary etiology(n=45).Univariate analysis revealed that platelet count(PLT),pre-procedural pressure gradient(pre-PPG),spleen dimensions(length,width,volume),and splenic vein parameters(diameter,flow)were significantly associated with rebleeding(all P<0.001).Multivariate regression identified PLT[odds ratio(OR)=0.980,95%confidence interval(CI):0.963-0.996],spleen length(OR=1.177,95%CI:1.002-1.381),spleen width(OR=1.425,95%CI:1.088-1.866),pre-PPG(OR=1.182,95%CI:1.067-1.309),and splenic vein diameter(OR=1.501,95%CI:1.074-2.097)as independent predictors(all P<0.05).The nomogram exhibited strong discrimination(AUC=0.883,95%CI:0.831-0.936)and favorable calibration(mean absolute error=0.046).Decision curve analysis confirmed a positive clinical net benefit.CONCLUSION The nomogram developed in this study enables the precise prediction of post-TIPS placement rebleeding risk,assisting clinicians in individualized risk stratification and postoperative therapeutic strategies. 展开更多
关键词 Transjugular intrahepatic portosystemic shunt Oesophagogastric variceal rebleeding Nomogram Predictive model Portal hypertension Stent patency Propensity score matching
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