Risk Factors Analysis And Establishment Of Risk Scoring System For Endoscopic Retrograde Cholangiopancreatography In Patients With Liver Cirrhosis

Liver cirrhosis is one of the common diseases of the digestive system,which often merge with impaired liver function,often associated with hypoproteinemia,ascites,PT prolongation,hepatic encephalopathy,hypersplenism,portal hypertension,thrombocytopenia,lack of blood volume,esophageal varices,renal dysfunction,liver and lung syndrome.Cirrhosis patients have a higher risk in the operation and a variety of interventional operation than general patient,because of the above-mentioned various secondary or primary disorders state.Endoscopic retrograde cholangiopancreatography is a common interventional procedure in gastroenterology,a number of studies have shown that cirrhosis patients have a higher risk of ERCP operation,but this risk is also associated with the disease status of cirrhotic patients..At present,there are few reports about the complications of ERCP after liver cirrhosis.To study the risk factors of postoperative complications in patients with liver cirrhosis after ERCP,and to identify high-risk patients,which is beneficial to strengthen the attention of high-risk patients and prevent the occurrence of complications.Part1:Analysis of risk factors for postoperative complications of ERCP in patients with liver cirrhosisAims: Retrospective analysis of patients with liver cirrhosis underwent ERCP postoperative complications in our hospital,to study the risk factors of postoperative pancreatitis(PEP),postoperative cholangitis,postoperative bleeding and total postoperative complicationsMethods: We retrospectively analyzed all kinds of data of patients with liver cirrhosis who were hospitalized with ERCP in our hospital from January 2009 to December 2015.The patients were preliminarily recorded the preoperative information,preoperative complications,cirrhosis,preoperative symptoms,Type of operation,intraoperative operation,postoperative complications.The postoperative pancreatitis,postoperative cholangitis,postoperative bleeding and postoperative complications were taken as dependent variables.The above related factors were used as independent variables,and the corresponding univariate analysis was performed.Results: 1?In this study,a total of 223 patients were included,including 38 cases of total postoperative complications,of which 10 cases of PEP,16 cases of cholangitis,10 cases of postoperative bleeding,6 cases of cardiopulmonary complications,3 cases of encephalopathy.2.The overall complication rate in Child-Pugh B and C patients was 21.7%,significantly higher than in Child-Pugh A group.The complication rate(37.5%)in Child-Pugh C group was higher than that in Child-Pugh A group and B group(12.6%).3.Univariate analysis of PEP showed that the risk factors of PEP were malignancy,platelet count,alkaline phosphatase(ALP)and bilirubin,pre-cut,and bile duct cell brush.4?Postoperative cholangitis univariate analysis found that ALP,albumin(ALB)is a risk factor for postoperative cholangitis.5?Univariate analysis of postoperative bleeding found that ascites,intraoperative bleeding,bilirubin,PT,INR,is a risk factor for postoperative bleeding.6 ? Univariate analysis of postoperative complications showed that ascites,esophageal varices,malignant,TBIL,PT,INR,ALB,biliary stent implantation were risk factors for postoperative complications.Conclusion: Overall,the incidence of postoperative complications in patients with liver cirrhosis after ERCP was slightly higher than that of normal subjects,and the incidence of postoperative complications was closely related to the liver function and general state.Part2:Establishment of risk scoring system for postoperative complications of ERCP in patients with liver cirrhosisAims: Multivariate regression analysis was performed on postoperative complications of ERCP in patients with liver cirrhosis.The independent risk factors for postoperative complications of liver cirrhosis were identified and a risk scoring system was established to predict the complications of ERCP in cirrhosis.Methods: Logstic regression analysis of the P <0.1 9 risk factors from the first part.After screening for independent risk factors,the continuous variables were transformed into categorical variables,and the scores were assigned according to the ? value of each independent risk factor,and a scoring system was established to predict the occurrence of postoperative complications.Through the ROC analysis,to understand its efficacy,and calculate its predictive complications of sensitivity,specificity,accuracy,positive predictive value,negative predictive value.Results: 1 ? Logistic regression analysis showed that the independent risk factors of postoperative complications of ERCP were: TBIL(OR:1.003).ALB(OR:0.935)is a protective factor.2.The TBIL can be divided into three sections: less than or equal to 31.4,[31.5-102.4],aged 102.5,in the same way ALB were divided into three groups: [31-36],aged 37,less than 30.The logstic regression of the group,according to its beta value,the above three groups were assigned,the score of TBIL three group was 0,1,2,while the score of ALB group was 0,1,1.The total score of 0-4 points,through ROC analysis,the area under the curve(AUC)was 0.689,similar to the Child-Pugh score and MELD score.3.Through the above scoring system,all patients were divided into 0-4 points,divided into 1.5 points,the patients were divided into high risk and low risk group.The sensitivity of the group was 89.4%,the specificity was 41.1%,the accuracy rate was 49.3%,the positive predictive value was 23.7% and the negative predictive value was 95%.Conclusion: TBIL is an independent risk factor for postoperative complications in patients with liver cirrhosis,and ALB is a protective factor,and the risk stratification system established by TBIL and ALB has a good predictive value for postoperative complications of ERCP in patients with liver cirrhosis.