The Value Of Liver Stiffness Measurement And Liver Fibrosis Score For Predicting Esophageal Variceal Rebleeding In Cirrhosis

Objective:Esophageal variceal rebleeding is a life-threatening complication of cirrhosis.However,the performance of non-invasive methods to assess the risk of experience of esophageal variceal rebleeding in patients,especially by non-invasive methods,is unclear.Therefore,this study evaluated the value of liver stiffness measurement(LSM)and liver non-invasive fibrosis score for predicting esophageal variceal rebleeding in patients with liver cirrhosis.Methods:The clinical baseline data of patients with first-time esophageal variceal bleeding who were hospitalized in the Department of Gastroenterology,the First Affiliated Hospital of Nanchang University from February 2017 to January 2021 and met the inclusion and exclusion criteria were retrospectively analyzed.Meanwhile,these patients were followed up.Cox regression analysis was performed to screen independent risk factors associated with rebleeding.Receiver operating characteristic curve(ROC)and time-dependent ROC was used to assess the ability of the noninvasive fibrosis score and LSM to predict esophageal variceal rebleeding in cirrhosis.Results:1.A total of 289 patients with cirrhosis were finally included in the analysis.The median follow-up time was 66.4 weeks.Use of nonselective beta-blocker(NSBB)drugs,LSM,hemoglobin levels,and platelet count as predictors of esophageal variceal rebleeding in cirrhosis.Based on these four parameters,a nomogram of esophageal variceal rebleeding in cirrhosis was constructed.The predictive power of the nomogram was assessed by the C-index(0.772,0.732–0.822).The results of the calibration plots show that the actual observed and predicted values obtained from the nomogram are in good agreement.2.In a stratified analysis based on a cohort of 194 patients with post-hepatitis B cirrhosis,rebleeding occurred in 55 patients during a median follow-up time of 68.28 weeks.The area under the ROC curve of LSM for predicting esophageal variceal rebleeding in cirrhosis was 0.837,and the time-dependent ROC curve also showed stable predictive performance of LSM.At the same time,the results showed that the predictive ability of liver noninvasive fibrosis,like APRI,FIB-4,King’s score,GUCI,Fibro Index,and Forns index was lower than that of LSM,with statistically significant.In addition,rebleeding was significantly reduced in patients with using NSBB drags and HBV-DNA negative patients.Conclusion:1.LSM can predict the risk of esophageal variceal rebleeding in patients with cirrhosis,and the nomogram is a routine tool for physicians to perform a personalized prognostic assessment.2.In the hepatitis B population,patients with HBV-DNA negative and patients who use NSBB drugs are less likely to experience esophageal variceal rebleeding.3.Compared with the non-invasive fibrosis score,LSM can more simply and accurately predict the rebleeding events of hepatitis B cirrhosis.