Analysis Of Prognostic Factors And Establishment Of Nomogram Model For Cirrhotic Patients With Esophageal And Gastric Variceal Bleeding

Objective Analyzing and exploring the independent prognostic factors that affect the overall survival(OS)of cirrhotic patients with esophageal and gastric variceal bleeding(EGVB).Establishing a survival prediction model in the form of nomogram,so as to provide reference for clinicians to make individualized prevention and treatment plans for patients,and further improve the prognosis.Methods Clinical data of cirrhotic patients with EGVB who were hospitalized in Northern Jiangsu People’s Hospital from October 2012 to September 2019 were collected.A total of 468 eligible patients were identified according to the inclusion and exclusion criteria.By reviewing the electronic medical records and telephone to identify the patient’s survival status as of September 2020 or the time of death.The 468 patients were randomly divided into the primary cohort and the validation cohort at a ratio of 7:3.In the primary cohort,univariate COX regression analysis and multivariate COX regression analysis were used to filter out the independent prognostic factors affecting the OS of patients,which were used to establish a prognostic model for predicting the patient’s OS,and presented in the form of nomogram.In the primary and validation cohort,the concordance index(C-index)and calibration curve were used to evaluate the predictive ability of model.In all patients,receiver operating characteristic curves were used to compare the predictive ability of nomogram model with Child-Turcotte-Pugh(CTP)score,Model for End-Stage Liver Disease(MELD)score and Model for End-Stage Liver Disease with Incorporation of Serum Sodium(MELD-Na)score in predicting 6-week and 1-year OS.In the primary cohort,risk stratification was performed according to the risk score of the nomogram model.Based on the risk stratification,Kaplan-Meier method was used for survival analysis in the validation cohort and all patients,and the the log-rank test was used for comparison between groups.Results Multivariate COX regression analysis showed that age,ascites,hemoglobin,serum sodium,estimated Glomerular Filtration Rate(eGFR),Albumin-Bilirubin(ALBI)scores were independent prognostic factors affecting OS(P<0.05).Based on the six independent prognostic factors,a predictive model was established and presented in the form of nomogram,and the 6-week,1-year,3-year OS of cirrhotic patients with EGVB were shown in the nomogram.In the primary cohort and validation cohort,the C-index of the nomogram model was 0.746 and 0.732,respectively.The calibration curves showed that the 6-week,1-year and 3-year OS predicted by the nomogram model were in good consistency with the actual 6-week,1-year and 3-year OS.In all patients,the Area Under the Curve(AUC)of 6-week and 1-year OS predicted by the nomogram model was 0.795 and 0.781,respectively.The AUC of 6-week OS predicted by the nomogram model was significantly higher than that of MELD score(AUC=0.72,P=0.03),but not significantly different from that of CTP score(AUC=0.752,P=0.136)and MELD-Na score(AUC=0.749,P=0.205).The AUC of 1-year OS predicted by the nomogram model was significantly higher than that of MELD score(AUC=0.688,P=0.001),CTP score(AUC=0.719,P=0.005)and MELD-Na score(AUC=0.718,P=0.012).In the primary cohort,patients were divided into high-risk,medium-risk,and low-risk groups according to the risk score of the nomogram model.In the validation cohort,the survival rate of patients in the high-risk group was significantly lower than that of the medium-risk group(χ2=7.135,P=0.008)and the low-risk group(χ2=19.096,P<0.001),and the survival rate of patients in the medium-risk group was significantly lower than that of the low-risk group(χ2=4.128,P=0.042).In all patients,the survival rate of patients in the high-risk group was significantly lower than that of the medium-risk group(χ2=23.914,P<0.001)and the low-risk group(χ2=125.815,P<0.001),and the survival rate of patients in the medium-risk group was significantly lower than that of the low-risk group(χ2=56.506,P<0.001).Conclusion Age,ascites,hemoglobin,serum sodium,eGFR,and ALBI score were independent prognostic factors affecting OS of cirrhotic patients with EGVB.The nomogram model established based on independent prognostic factors of OS could predict the prognosis of patients more accurately.Risk stratification based on the risk score of the nomogram model could distinguish patients with different risk levels,and assist clinicians to assess the disease severity and make individualized prevention and treatment plans.