Nomogram based on spleen volume expansion rate predicts esophagogastric varices bleeding risk in patients with hepatitis B liver cirrhosis

Abstract

BackgroundWe aimed to explore the risk factors for hemorrhage of esophagogastric varices (EGVs) in patients with hepatitis B cirrhosis and to construct a novel nomogram model based on the spleen volume expansion rate to predict the risk of esophagogastric varices bleeding.MethodsUnivariate and multivariate logistic regression analysis was used to analyze the risk factors for EGVs bleeding. Nomograms were established based on the multivariate analysis results. The predictive accuracy of the nomograms was assessed using the area under the curve (AUC or C-index) of the receiver operating characteristic (ROC) and calibration curves. Decision curve analysis was used to determine the clinical benefit of the nomogram. We created a nomogram of the best predictive models.ResultsA total of 142 patients' hepatitis B cirrhosis with esophagogastric varices were included in this study, of whom 85 (59.9%) had a history of EGVs bleeding and 57 (40.1%) had no EGVs bleeding. The spleen volume expansion rate, serum sodium levels (mmol/L), hemoglobin levels (g/L), and prothrombin time (s) were independent predictors for EGVs bleeding in patients with hepatitis B liver cirrhosis (P < 0.05). The above predictors were included in the nomogram prediction model. The area under the ROC curve (AUROC) of the nomogram was 0.781, the C-index obtained by internal validation was 0.757, and the calibration prediction curve fit well with the ideal curve. The AUROCs of the PLT-MELD and APRI were 0.648 and 0.548, respectively.ConclusionIn this study, a novel nomogram for predicting the risk of EGVs bleeding in patients with hepatitis B cirrhosis was successfully constructed by combining the spleen volume expansion rate, serum sodium levels, hemoglobin levels, and prothrombin time. The predictive model can provide clinicians with a reference to help them make clinical decisions.

Assessment of nomogram model for the prediction of esophageal variceal hemorrhage in hepatitis B-induced hepatic cirrhosis

“…Albumin (ALB) has been identified as one of the useful predictors of EVH [29,33,40]. Hemoglobin (HB) is reported as another independent risk factor to evaluate EVH in HBV-induced cirrhosis patients [41]. Spleen width (SW) has also been suggested as an independent predictor of EVH [42].…”

The impact of hepatic and splenic volumetric assessment in imaging for chronic liver disease: a narrative review

“…The presence and risk of bleeding of gastroesophageal varices represent an important part of the initial assessment and monitoring of CLD patients with portal hypertension [ 89 ]. Studies utilising volumetry for assessment of this specific outcome are summarised in Supplementary Table 5 [ 30 , 33 – 38 , 55 , 57 , 108 – 114 ]. Kim et al assessed CLD patients for the presence of varices and the development of variceal bleeding.…”

“…This is evidenced by data from a large cohort from the United States of 8853 patients undergoing CT colonography or CT for renal donor work-up whereby the mean spleen volume for males and females was 216 ± 100 cm 3 [39]. A summary of studies reporting normal spleen volumes is provided in Supplementary Table 7 [22,24,31,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57]. Such countryspecific thresholds for normal splenic volume remain below the reported splenic volumes for CLD patients with no hepatic fibrosis (Table 2).…”