Establishment And Validation Of Clinical Prediction Model For Stent Rerestenosis After TIPS In Patients With Hepatitis B Cirrhosis

ObjectivesTo explore the risk factors of stent restenosis after transjugular intrahepatic portosystemic shunt(TIPS)in patients with hepatitis B cirrhosis.To establish and verify the nomograph prediction model of stent restenosis after TIPS in patients with hepatitis B cirrhosis,and to evaluate its clinical value.To provide a quantitative tool for predicting the risk and benefit of stent restenosis in these patients after TIPS treatment.MethodsThe clinical data of 355 patients with hepatitis B cirrhosis treated by TIPS in the first affiliated Hospital of Zhengzhou University from January 2012 to January 2020 were analyzed retrospectively.About 70%(249 cases)of the patients were randomly selected as the modeling population,and the other 30%(106 cases)were selected as the verification population.According to the presence or absence of stent restenosis within 1 year after operation,the modeling population was divided into stent restenosis group(32 cases)and stent non-stenosis group(217 cases).Through univariate and multivariate Logistic regression analysis,the independent risk factors of stent restenosis in patients with hepatitis B cirrhosis after TIPS were screened,and the independent risk factors were used to construct a line chart prediction model.The validation population was used to evaluate the accuracy of the prediction model by internal verification.The area under ROC curve(AUC),Calibration scatter plot and DCA decision curve analysis were used to evaluate the differentiation,calibration and clinical practicability of the prediction model.ResultsUnivariate Logistic analysis showed that there were significant differences in age,diabetes,portal vein thrombosis,splenectomy history,platelet,international standardized ratio(INR),portal vein puncture position and stent position between stent restenosis group and non-stent restenosis group.The above factors were included in multivariate Logistic regression analysis.Diabetes,splenectomy history,portal vein puncture location and stent location were independent risk factors for stent restenosis after TIPS in patients with hepatitis B cirrhosis.The above independent risk factors were included and the line chart prediction model was successfully established.The area under the ROC curve of the modeling group and the verification group is 0.817(95%CI:0.731-0.903)and 0.804(95%CI:0.673-0.935),respectively,indicating that the discrimination of the prediction model is good;the calibration curves of the modeling group and the verification group show good consistency,and the model fits well;the DCA curve shows that the model has good clinical practicability.ConclusionsThe independent risk factors of stent restenosis in patients with hepatitis B cirrhosis after TIPS include diabetes,splenectomy history,portal vein puncture position and stent location.A nomograph prediction model is constructed based on the above risk factors,which has good clinical practicability.It provides a quantitative tool for predicting and benefiting such patients after TIPS treatment,which is helpful for early screening of high-risk patients and making better clinical decisions.