Analysis Of Risk Factors And Establishment Of Prediction Model Of Biliary Fistula In Hepatic Cystic Echinococcosis

OBJECTIVE: To explore the related risk factors of hepatic cystic hydatid disease with biliary fistula,and establish a visual nomograph model with predictive value on this basis,so as to predict the occurrence of biliary fistula in patients with hepatic cystic hydatid disease and provide reference for the selection of diagnosis and treatment strategies.Methods: Retrospective analysis of clinical data of 196 patients with hydatid disease admitted to Xinjiang Uygur Autonomous Region People’s Hospital from December 2018 to December 2022,and analysis was conducted based on the following indicators:(1)general indicators,(2)laboratory indicators,and(3)imaging data.And all patients collected were divided into biliary fistula group and non biliary fistula group based on the presence or absence of biliary fistula during surgery.SPSS software was used to perform single factor,multiple factor,and multi factor analysis on the data to determine the risk factors for biliary fistula in patients with hepatic cystic hydatid disease.A predictive model was established and evaluated based on the logistic regression results of multiple factors.Finally,a decision curve and clinical impact curve were established to investigate the net benefit of patients based on the Nomogram prediction scoring system and the evaluation model.Result: By collecting medical records of patients with hepatic cystic echinococcosis diagnosed and treated at the People’s Hospital of Xinjiang Uygur Autonomous Region from December 2018 to December 2022,univariate analysis of variance and multivariate logistic regression analysis were performed on the observation indicators.Ultimately,it can be concluded that: total bilirubin>17 γ-Glutamic transferase>19,alkaline phosphatase(ALP)>77.8,white blood cells>8.39,cyst size>80,cyst location,and cyst classification may be risk factors for biliary fistula.The above influencing factors were used as predictive factors to establish a risk prediction model for the occurrence of biliary fistula in hepatic cystic echinococcosis.Nomogram was used for validation,and the prediction accuracy of the scoring system was C-index=91.48%,with a confidence interval of 86.61%～96.34% for C-index.And in order to verify the accuracy of the scoring system,a calibration plot was drawn,and the predicted results were very accurate.Further draw the decision curve and clinical impact curve based on the results,and finally prove that the Nomogram prediction scoring system has a higher net benefit for patients compared to those who choose any single indicator for prediction.Choosing Nomogram to predict whether patients will experience biliary fistula has a higher net benefit and is considered a good evaluation tool.Conclusion: Total bilirubin,γ-glutamyl transpeptidase,alkaline phosphatase(ALP),leukocytes,cyst size,cyst site and cyst staging were independent risk factors for the development of biliary fistula in patients with hepatic cysticercosis,and there was a correlation between abdominal pain and the development of biliary fistula.The risk prediction model for biliary fistula in hepatic cysticercosis based on the above independent risk factors can provide some reference value for clinicians and has some clinical application.