Establishment and validation of a nomogram for predicting esophagogastric variceal bleeding in patients with liver cirrhosis

doi:10.3748/wjg.v31.i9.102714

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World Journal of Gastroenterology

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World J Gastroenterol. Mar 7, 2025; 31(9): 102714
Published online Mar 7, 2025. doi: 10.3748/wjg.v31.i9.102714

Table 1 Baseline characteristics of patients with cirrhosis in the control and esophagogastric variceal bleeding groups, n (%)

Characteristics	non-EGVB group (n = 864)	EGVB group (n = 251)	P value
Age (years), median (IQR)	62 (54, 71)	57 (50, 67)	< 0.001
Gender			0.034
Female	281 (33)	64 (25)
Male	583 (67)	187 (75)
WBC (× 10⁹/L), median (IQR)	4.1 (2.9, 5.9)	6.3 (4.4, 9.2)	< 0.001
HGB (g/L), median (IQR)	102 (81, 122)	80 (61, 101)	< 0.001
PLT (× 10⁹/L), median (IQR)	80 (53, 112)	91 (68, 115)	0.001
NEUT (× 10⁹/L), median (IQR)	2.63 (1.83, 4.11)	4.41 (2.85, 6.70)	< 0.001
NLR, median (IQR)	3.3 (2.1, 5.4)	3.9 (2.5, 6.3)	0.006
APTT (second), median (IQR)	31 (27, 37)	28 (25, 33)	< 0.001
PTA (%), median (IQR)	68 (54, 82)	66 (55, 79)	0.162
INR, median (IQR)	1.28 (1.13, 1.40)	1.30 (1.20, 1.47)	0.041
TT, median (IQR)	19.00 (17.48, 21.00)	19.00 (18.00, 21.00)	0.984
PT, median (IQR)	13.90 (12.50, 15.70)	14.10 (12.85, 15.50)	0.194
Fbg (g/L), median (IQR)	1.80 (1.40, 2.30)	1.53 (1.20, 1.95)	< 0.001
ALB (g/L), median (IQR)	31.0 (27.0, 35.0)	32.0 (28.5, 36.0)	0.046
TBIL (μmol/L), median (IQR)	26 (16, 44)	18 (12, 28)	< 0.001
ALT (U/L), median (IQR)	33 (21, 55)	30 (21, 43)	0.08
AST (U/L), median (IQR)	42 (27, 72)	35 (24, 55)	< 0.001
TBA (μmol/L), median (IQR)	35 (17, 69)	19 (9, 37)	< 0.001
BUN (μmol/L), median (IQR)	5.5 (4.1, 7.7)	8.4 (6.1, 11.7)	< 0.001
CREA (μmol/L), median (IQR)	66 (54, 83)	68 (54, 84)	0.96
Na (mmol/L), median (IQR)	139.7 (136.9, 142.0)	139.4 (137.0, 142.0)	0.838
Ascites			< 0.001
No	348 (40)	145 (58)
Yes	516 (60)	106 (42)
Hepatic encephalopathy			0.378
No	783 (90.6)	232 (92.4)
Yes	81 (9.4)	19 (7.6)
Child-Pugh grade			0.018
A and B	647 (75)	206 (82)
C	217 (25)	45 (18)
Propranolol			0.212
No	802 (92.8)	227 (90.4)
Yes	62 (7.2)	24 (9.6)
Bleeding history			< 0.001
No	684 (79)	160 (64)
Yes	180 (21)	91 (36)
PVT			0.014
No	800 (92.6)	220 (88)
Yes	64 (7.4)	31 (12)
Diabetes mellitus			0.669
No	532 (73)	187 (75)
Yes	232 (27)	64 (25)
Etiology			0.729
Viral	371 (43)	109 (43)
Alcoholic	196 (23)	64 (25)
Mixed	73 (8.4)	19 (7.6)
Others	224 (26)	59 (24)

IQR: Interquartile range; EGVB: Esophagogastric variceal bleeding; TBA: Total bile acid; WBC: White blood cell; HGB: Hemoglobin; PLT: Platelet; NEUT: Neutrophil; NLR: Neutrophil/lymphocyte ratio; APTT: Activated partial thromboplastin time; PTA: Prothrombin activity; INR: International normalized ratio; TT: Thromboplastin time; PT: Prothrombin time; Fbg: Fibrinogen; ALB: Albumin; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; TBIL: Total bilirubin; BUN: Blood urine nitrogen; CREA: Creatinine; Na: Sodium; PVT: Portal vein thrombosis; Propranolol: History of propranolol intake within six months; Bleeding history: History of esophagogastric variceal bleeding within six months; Mixed: Viral + alcoholic.

Table 2 Characteristics of patients with cirrhosis in the training and validation cohorts, n (%)

Characteristics	Training cohort (n = 669)	Validation cohort (n = 446)	P value
EGVB			0.953
No	518 (77)	346 (78)
Yes	151 (23)	100 (22)
Age (years), median (IQR)	60 (52, 70)	60 (52, 70)	0.814
Gender			0.508
Female	202 (30)	143 (32)
Male	467 (70)	303 (68)
WBC (× 109/L), median (IQR)	4.5 (3.2, 6.8)	4.4 (3.0, 6.4)	0.106
HGB (g/L), median (IQR)	97 (76, 119)	97 (75, 118)	0.799
PLT (× 10⁹/L), median (IQR)	84 (58, 115)	78 (53, 112)	0.097
NEUT (× 10⁹/L), median (IQR)	3.00 (2.00, 4.88)	2.90 (1.90, 4.49)	0.19
NLR, median (IQR)	3.4 (2.2, 5.5)	3.3 (2.1, 5.7)	0.761
APTT (second), median (IQR)	30 (27, 36)	30 (27, 37)	0.695
PTA (%), median (IQR)	68 (55, 82)	66 (52, 81)	0.197
INR, median (IQR)	1.28 (1.14, 1.40)	1.30 (1.17, 1.47)	0.156
TT, median (IQR)	19.00 (17.30, 20.90)	19.00 (18.00, 21.00)	0.112
PT, median (IQR)	13.80 (12.60, 15.50)	14.00 (12.50, 15.90)	0.244
Fbg (g/L), median (IQR)	1.76 (1.36, 2.24)	1.70 (1.35, 2.20)	0.589
ALB (g/L), median (IQR)	31.1 (27.0, 35.0)	31.0 (27.0, 35.0)	0.409
TBIL (μmol/L), median (IQR)	24 (14, 40)	23 (15, 43)	0.592
ALT (U/L), median (IQR)	31 (20, 52)	33 (22, 53)	0.346
AST (U/L), median (IQR)	40 (26, 69)	41 (28, 64)	0.289
TBA (μmol/L), median (IQR)	29 (14, 58)	31 (15, 70)	0.083
BUN (μmol/L), median (IQR)	6.0 (4.3, 9.0)	5.9 (4.5, 8.6)	0.898
CREA (μmol/L), median (IQR)	66 (54, 82)	67 (54, 84)	0.963
Na (mmol/L), median (IQR)	140.0 (137.0, 142.0)	139.0 (136.0, 141.7)	0.323
Ascites			0.445
No	302 (45)	191 (43)
Yes	367 (55)	255 (57)
Hepatic encephalopathy			0.392
No	605 (90.4)	410 (91.9)
Yes	64 (9.6)	36 (8.1)
Child-Pugh grade			0.751
A and B	514 (77)	339 (76)
C	155 (23)	107 (24)
Propranolol			0.714
No	619 (92.5)	410 (91.9)
Yes	50 (7.5)	36 (8.1)
Bleeding history			0.732
No	504 (75)	340 (76)
Yes	165 (25)	106 (24)
PVT			0.511
No	609 (91)	411 (92.2)
Yes	60 (9.0)	35 (7.8)
Diabetes mellitus			0.293
No	499 (75)	320 (72)
Yes	170 (25)	126 (28)
Etiology			0.035
Viral	290 (43)	190 (43)
Alcoholic	172 (26)	88 (20)
Mixed	47 (7.0)	45 (10)
Others	160 (24)	123 (28)

Table 3 Multivariate logistic regression analysis

Characteristics	OR	95%CI	P value
Age	0.98	0.96-1.00	0.08
WBC	1.25	1.16-1.34	< 0.001
HGB	0.98	0.98-0.99	< 0.001
APTT	0.95	0.91-0.98	0.002
Fbg	0.33	0.22-0.47	< 0.001
TBIL	0.98	0.97-0.99	0.007
TBA	0.99	0.98-1.00	0.012
BUN	1.04	0.99-1.10	0.159
Ascites (yes)	0.52	0.32-0.83	0.006

OR: Odds ratio; CI: Confidence interval; WBC: White blood cell; HGB: Hemoglobin; APTT: Activated partial thromboplastin time; Fbg: Fibrinogen; TBA: Total bile acid; TBIL: Total bilirubin; BUN: Blood urine nitrogen.

Citation: Liang LX, Liang X, Zeng Y, Wang F, Yu XK. Establishment and validation of a nomogram for predicting esophagogastric variceal bleeding in patients with liver cirrhosis. World J Gastroenterol 2025; 31(9): 102714
URL: https://www.wjgnet.com/1007-9327/full/v31/i9/102714.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i9.102714