Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2025; 31(9): 102714
Published online Mar 7, 2025. doi: 10.3748/wjg.v31.i9.102714
Establishment and validation of a nomogram for predicting esophagogastric variceal bleeding in patients with liver cirrhosis
Lun-Xi Liang, Xiao Liang, Ya Zeng, Fen Wang, Xue-Ke Yu
Lun-Xi Liang, Fen Wang, Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha 410013, Hunan Province, China
Lun-Xi Liang, Ya Zeng, Xue-Ke Yu, Department of Gastroenterology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha 410008, Hunan Province, China
Lun-Xi Liang, Fen Wang, Hunan Key Laboratory of Nonresolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha 410006, Hunan Province, China
Xiao Liang, School of Clinical Medicine, Changsha Medical University, Changsha 410200, Hunan Province, China
Co-corresponding authors: Fen Wang and Xue-Ke Yu.
Author contributions: Liang LX, Wang F and Yu XK designed the research study; Liang LX, Liang X and Zeng Y contributed data collection and analysis; Liang LX wrote the first draft of the manuscript; Wang F and Yu XK conceived and supervised the manuscript; All authors have read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 82270594; the National Natural Science Foundation for Youths of China, No. 82103151; the Fundamental Research Funds for the Central Universities of Central South University, No. 2022ZZTS0265; and the Graduate Research Innovation Project of Hunan Province, No. CX20220347.
Institutional review board statement: The study protocol was approved by the Ethics Committee of Changsha Central Hospital (Changsha Central Hospital Affiliated with the University of South China, approval No. 2022-S0019).
Informed consent statement: The necessity for obtaining informed written consent was waived due to the retrospective nature of the study, which did not implicate the privacy or commercial interests of the patients. Additionally, measures were implemented to anonymize biological samples, and a stringent data security management and technical protection system was established for the storage, utilization, and dissemination of biological samples and data, thereby ensuring the security of data and personal information.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Data used and/or analyzed in the current study could be acquired from the corresponding author upon reasonable request.
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: Xue-Ke Yu, MD, Department of Gastroenterology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, No. 161 Shaoshan South Road, Changsha 410008, Hunan Province, China. yuxueke2023@163.com
Received: October 28, 2024
Revised: January 6, 2025
Accepted: January 18, 2025
Published online: March 7, 2025
Processing time: 114 Days and 17.8 Hours
Abstract
BACKGROUND

Patients with decompensated liver cirrhosis suffering from esophagogastric variceal bleeding (EGVB) face high mortality.

AIM

To investigate the risk factors for EGVB in patients with liver cirrhosis and establish a diagnostic nomogram.

METHODS

Patients with liver cirrhosis who met the inclusion criteria were randomly divided into training and validation cohorts in a 6:4 ratio in this retrospective research. Univariate analysis, least absolute shrinkage and selection operator regression, and multivariate analysis were employed to establish the nomogram model. Calibration curve, the area under the receiver operating characteristic curve (AUC), and decision curve analysis (DCA) were applied to assess the discrimination, accuracy, and clinical practicability of the nomogram, respectively.

RESULTS

A total of 1115 patients were enrolled in this study. The nomogram was established based on white blood cells (P < 0.001), hemoglobin (P < 0.001), fibrinogen (P < 0.001), total bilirubin (P = 0.007), activated partial thromboplastin time (P = 0.002), total bile acid (P = 0.012), and ascites (P = 0.006). The calibration curve indicated that the actual observation results were in good agreement with the prediction results of the model. The AUC values of the diagnostic model were 0.861 and 0.859 in the training and validation cohorts, respectively, which were higher than that of the aspartate aminotransferase-to-platelet ratio index, fibrosis index based on 4 factors, and aspartate aminotransferase-to-alanine aminotransferase ratio. Additionally, DCA indicated that the net benefit value of the model was higher than that of the other models.

CONCLUSION

This research constructed and validated a nomogram with perfect performance for predicting EGVB events in patients with liver cirrhosis, which could help clinicians with timely diagnosis, individualized treatment, and follow-up.

Keywords: Liver cirrhosis; Esophagogastric variceal bleeding; Diagnostic model; Nomogram; Retrospective study

Core Tip: This research retrospectively investigated the risk factors for esophagogastric variceal bleeding in patients with liver cirrhosis and established a diagnostic nomogram based on white blood cells, hemoglobin, fibrinogen, total bilirubin, activated partial thromboplastin time, total bile acid, and ascites. This model was further verified in the validation cohort and proved to perform well. The factors included in this model are non-invasive, inexpensive, and readily available on admission, which has excellent clinical promotion value.