Analysis Of Risk Factors And Establishment Of Nomogram Prediction Model Of Portal Vein Thrombosis In Patients With Liver Cirrhosis

Objective:to analyze and screen the independent risk factors of portal vein thrombosis in patients with decompensated liver cirrhosis,and to establish and verify a line chart predictive model,so as to provide clinical basis for the prevention and early detection of portal vein thrombosis in patients with liver cirrhosis.Methods:The data of 275 patients with decompensated liver cirrhosis in Shaanxi Provincial people’s Hospital from January 2019 to December 2020 were collected and divided into PVT group(n=60)and control group(n=215)according to imaging examination.The differences of general and clinical data between the two groups were retrospectively analyzed,including general condition,past history,serological index,imaging examination,endoscopic examination,Child-Pugh classification of liver function,etc.T-test or Mann-Whitney U test was used to compare the measurement data between the two groups,and?~2test was used to compare the counting data between the two groups.Independent risk factors were screened by multi-factor Logistic regression analysis.Based on the results of multi-factor regression,the nomogram was established and tested.C-index and calibration curve Calibrated diagram were used to evaluate its performance.Results:1.Univariate analysis showed that the PVT group was compared with the control group.In the history of alcohol and tobacco,splenectomy,blood transfusion,beta-blocker use,gastrointestinal bleeding,endoscopic treatment,hospitalization days,hospitalization times,hospitalization costs,average platelet volume,PDW,TBIL,TP,ALB,Na~+,PT,D-dimer,Child-Pugh grade,varicose degree,site of varicose veins,red sign,portal hypertensive gastropathy,main portal vein,splenic vein diameter,There were statistical differences in the thickness of spleen and the degree of ascites(p<0.05).2.Multivariate analysis showed the history of splenectomy(OR=1.454,95%CI0.671-3.147),the degree of varicose veins(OR=16.085,95%CI 2.625-98.575),PT(OR=1.179,95%CI 1.033-1.346),D-dimer(OR=1.209,95%CI 1.008-1.449)and portal vein diameter(OR=1.286,95%CI 1.118-1.478)is an independent risk factor for portal vein thrombosis in patients with liver cirrhosis.PDW(OR=0.770,95%CI 0.638-0.928)and ALB(OR=0.846,95%CI 0.765-0.937)are protective factors for portal vein thrombosis in patients with liver cirrhosis.3.Based on the results of multi-factor regression,nomogram is established.The C-index is 0.867,95%CI,0.818-0.915.The calibration curve shows that there is a good agreement between the observed and predicted values of PVT.Conclusion:1.Compared with the control group,the PVT group had higher Child-Pugh grade,more times of gastrointestinal bleeding and endoscopic treatment,more severe varicose veins,higher positive rate of red sign and portal hypertensive gastropathy,wider diameter of main portal vein and splenic vein,thicker spleen,and more ascites.The hospitalization days,hospitalization times and hospitalization expenses in the PVT group were higher than those in the control group,which aggravated the medical burden.Previous splenectomy increases the risk of PVT formation.2.The history of splenectomy,the degree of varicose veins,plasma prothrombin time,D-dimer and portal vein diameter were independent risk factors for the formation of PVT,while platelet volume distribution width and albumin level were protective factors.3.Based on the established line diagram,it has a good predictive value,and provides a more convenient,quantitative and intuitive tool for clinicians to evaluate the risk of PVT formation.