Observational Study
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World J Gastroenterol. Jan 14, 2025; 31(2): 100234
Published online Jan 14, 2025. doi: 10.3748/wjg.v31.i2.100234
Prognostic model for esophagogastric variceal rebleeding after endoscopic treatment in liver cirrhosis: A Chinese multicenter study
Jun-Yi Zhan, Jie Chen, Jin-Zhong Yu, Fei-Peng Xu, Fei-Fei Xing, De-Xin Wang, Ming-Yan Yang, Feng Xing, Jian Wang, Yong-Ping Mu
Jun-Yi Zhan, Fei-Peng Xu, Fei-Fei Xing, De-Xin Wang, Ming-Yan Yang, Yong-Ping Mu, Cell Biology Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Jun-Yi Zhan, Fei-Peng Xu, Fei-Fei Xing, De-Xin Wang, Ming-Yan Yang, Yong-Ping Mu, Institute of Liver Diseases, Shanghai Academy of Chinese Medicine, Shanghai 201203, China
Jun-Yi Zhan, Fei-Peng Xu, Fei-Fei Xing, De-Xin Wang, Ming-Yan Yang, Yong-Ping Mu, Clinical Key Laboratory of Traditional Chinese Medicine of Shanghai, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Jun-Yi Zhan, Fei-Peng Xu, Fei-Fei Xing, De-Xin Wang, Ming-Yan Yang, Yong-Ping Mu, Key Laboratory of Liver and Kidney Disease of the Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Jie Chen, Jian Wang, Department of Gastroenterology and Hepatology, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
Jie Chen, Jian Wang, Shanghai Institute of Liver Disease, Fudan University, Shanghai 200032, China
Jie Chen, Evidence-Based Medicine Center, Fudan University, Shanghai 200032, China
Jin-Zhong Yu, Department of Gastrointestinal Endoscopy, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Feng Xing, Department of Hepatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Co-first authors: Jun-Yi Zhan and Jie Chen.
Co-corresponding authors: Jian Wang and Yong-Ping Mu.
Author contributions: Zhan JY and Chen J have contributed equally to this work and share first authorship; Mu YP and Wang J have contributed equally to this work and share co-corresponding authorship; Mu YP, Wang J, and Zhan JY carried out study concept and design; Zhan JY carried out interpretation of data and drafting of the manuscript; Zhan JY, Chen J, Yu JZ, Xu FP, Xing FF, Wang DX, Yang MY, and Xing F carried out collection of data; Zhan JY, Chen J, and Yu JZ were involved in analysis of data; Mu YP, Wang J, and Chen J were involved in critical revision for important intellectual content; and all authors have read and approve the final manuscript.
Supported by National Natural Science Foundation of China, No. 81874390 and No. 81573948; Shanghai Natural Science Foundation, No. 21ZR1464100; Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission, No. 22S11901700; and the Shanghai Key Specialty of Traditional Chinese Clinical Medicine, No. shslczdzk01201.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Shuguang Hospital (Approval No. 2017-560-43) and Zhongshan Hospital (Approval No. B2023-055R).
Informed consent statement: Informed consent was not required for this study as the data was de-identified when outputting data from electronic medical records.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Statistical code and the dataset supporting the findings of this study are available from the corresponding author upon reasonable request. Requests should be directed to ypmu8888@126.com. Data will be shared following approval of a reasonable request and may require a signed data use agreement to ensure the protection of sensitive information.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Ping Mu, MD, PhD, Chief Physician, Cell Biology Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Pudong District, Shanghai 201203, China. ypmu8888@126.com
Received: August 10, 2024
Revised: September 28, 2024
Accepted: October 25, 2024
Published online: January 14, 2025
Processing time: 129 Days and 17.6 Hours
Abstract
BACKGROUND

Rebleeding after recovery from esophagogastric variceal bleeding (EGVB) is a severe complication that is associated with high rates of both incidence and mortality. Despite its clinical importance, recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.

AIM

To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.

METHODS

This study included 477 EGVB patients across 2 cohorts: The derivation cohort (n = 322) and the validation cohort (n = 155). The primary outcome was rebleeding events within 1 year. The least absolute shrinkage and selection operator was applied for predictor selection, and multivariate Cox regression analysis was used to construct the prognostic model. Internal validation was performed with bootstrap resampling. We assessed the discrimination, calibration and accuracy of the model, and performed patient risk stratification.

RESULTS

Six predictors, including albumin and aspartate aminotransferase concentrations, white blood cell count, and the presence of ascites, portal vein thrombosis, and bleeding signs, were selected for the rebleeding event prediction following endoscopic treatment (REPET) model. In predicting rebleeding within 1 year, the REPET model exhibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort, alongside 0.862 and 0.127 in the validation cohort. Furthermore, the REPET model revealed a significant difference in rebleeding rates (P < 0.01) between low-risk patients and intermediate- to high-risk patients in both cohorts.

CONCLUSION

We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive performance, which will improve the clinical management of rebleeding in EGVB patients.

Keywords: Esophagogastric variceal bleeding; Variceal rebleeding; Liver cirrhosis; Prognostic model; Risk stratification; Secondary prophylaxis

Core Tip: Rebleeding is a serious complication in liver cirrhosis patients following esophagogastric variceal bleeding, and there is no widely recognized prognostic model to reliably predict this risk. To address this gap, we developed and externally validated the rebleeding event prediction following endoscopic treatment model, which incorporates readily accessible clinical variables from multiple domains. The rebleeding event prediction following endoscopic treatment model enables effective risk stratification, facilitating improved patient management and the tailoring of follow-up and treatment strategies.