Development of a new Cox model for predicting long-term survival in hepatitis cirrhosis patients underwent transjugular intrahepatic portosystemic shunts

doi:10.4240/wjgs.v16.i2.491

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Feb 27, 2024 (publication date) through Dec 19, 2024

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World Journal of Gastrointestinal Surgery

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastrointest Surg. Feb 27, 2024; 16(2): 491-502
Published online Feb 27, 2024. doi: 10.4240/wjgs.v16.i2.491

Table 1 Baseline characteristics of patients in the training and validation cohorts

	Training cohort (n = 157)	Validation cohort (n = 67)	P value
Age (yr)	51.9 ± 11.4	54.8 ± 9.0	0.05
Sex, n (%)			0.714
Male	123 (78)	51 (76)
Female	34 (22)	16 (24)
Etiology of cirrhosis, n (%)			0.251
Hepatitis B	137 (87)	62 (92)
Hepatitis C	20 (13)	5 (8)
Indication, n (%)			0.935
Variceal bleeding	89 (57)	37 (55)
Ascites	34 (21)	16 (24)
Both	34 (22)	14 (21)
Shunt, n (%)			0.118
Reasonable	83 (53)	43 (64)
Unreasonable	74 (47)	24 (36)
HE before TIPS, n (%)			0.015
Grade 0	155 (99)	62 (92)
Grade 1-2	1 (0.5)	1 (2)
Grade 3-4	1 (0.5)	4 (6)
Ascites, n (%)			0.199
None	70 (45)	26 (39)
Mild	30 (19)	9 (13)
Severe	57 (36)	32 (48)
Pre-PPG (mmHg)	26.1 ± 6.0	27.4 ± 7.7	0.153
Post-PPG (mmHg)	13.4 ± 5.8	14.2 ± 6.2	0.530
PVP%	32.2 ± 13.5	32.6 ± 12.1	0.587
Laboratory values
ALT (U/L)	26.2 ± 25.3	23.7 ± 12.0	0.686
AST (U/L)	35.4 ± 32.6	31.8 ± 13.5	0.596
ALB (g/L)	36.1 ± 4.6	35.7 ± 4.6	0.736
Na (mmol/L)	139.5 ± 4.2	138.1 ± 4.5	0.014
ICGR15 (%)	39.7 ± 16.1	43.0 ± 17.7	0.150
INR	1.3 ± 0.2	1.3 ± 0.2	0.514
Cr (mol/L)	70.3 ± 24.0	76.6 ± 33.9	0.362
Tbil (mol/L)	26.3 ± 14.9	28.3 ± 16.6	0.440
WBC (× 10⁹/L)	3.3 ± 2.4	3.5 ± 2.7	0.942
PLT (× 10⁹/L)	95.4 ± 25.0	98.9 ± 25.9	0.231
HGB (g/L)	100.1 ± 89.8	98.3 ± 82.7	0.984
Child-Pugh	6.9 ± 1.5	7.2 ± 1.7	0.152
Child classification, n (%)			0.142
Child A	68 (43)	22 (33)
Child B	82 (52)	41 (61)
Child C	7 (5)	4 (6)
MELD	8.0 ± 4.3	9.0 ± 5.1	0.295
MELD-Na	9.0 ± 5.7	11.2 ± 6.6	0.032
FIPS	-1.0 ± 0.8	-0.8 ± 0.8	0.111
6-yr survival (%)	49.9%	39.1%	0.233

ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; Cr: Creatinine; FIPS: Freiburg index of post-transjugular intrahepatic portosystemic shunt survival; HE: Hepatic encephalopathy; HGB: Hemoglobin; ICGR15: Indocyanine green retention rate at 15 min; INR: International normalized ratio; MELD: Model for end-stage liver disease; Na: Sodium; PLT: Platelet; PVP: Portal venous pressure; Tbil: Total bilirubin; TIPS: Transjugular intrahepatic portosystemic shunt; WBC: White blood cell.

Table 2 Univariate and multivariate Cox proportional hazards regression models for prognostic factors after transjugular intrahepatic portosystemic shunt placement

	Univariable model				Multivariable model
	HR		95%CI	P value	HR		95%CI	P value
Etiology	0.29	1.34	0.60-2.98	0.48
Indication
Variceal bleeding
Ascites	1.36	3.90	2.01-7.58	< 0.001	1.45	4.27	2.04-8.94	< 0.001^b
Both	1.01	2.76	1.34-5.65	0.006	1.00	2.72	1.24-5.97	0.01^b
Shunt	1.20	3.33	1.87-5.94	< 0.001	1.83	6.26	2.67-14.63	< 0.001^b
Age	-0.02	0.99	0.96-1.01	0.18
Pre-PPG	0.10	1.10	1.05-1.15	< 0.001
Post-PPG	0.25	1.29	1.21-1.37	< 0.001	0.27	1.32	1.22-1.42	< 0.001^b
PVP decrease	-0.09	0.92	0.89-0.94	< 0.001	-0.04	0.96	0.93-1.00	0.03^a
ALT	-0.001	1.00	0.99-1.01	0.81
AST	0.0008	1.00	0.99-1.01	0.83
ALB	-0.004	1.00	0.94-1.06	0.88
Na	-0.05	0.95	0.89-1.02	0.13
ICGR15	0.04	1.04	1.03-1.06	< 0.001	0.05	1.05	1.03-1.07	< 0.001^b
1/INR	-2.99	0.05	0.003-0.77	0.03
Log₁₀ (Cr)	0.46	1.58	0.20-12.50	0.67
Log₁₀ (Tbil)	2.95	19.16	4.87-75.41	< 0.001	2.24	9.38	2.16-40.82	0.002^b
Log₁₀ (WBC)	-0.43	0.65	0.21-1.99	0.45
Log₁₀ (PLT)	-1.17	0.31	0.12-0.78	0.01
Log₁₀ (HGB)	1.94	6.98	0.52-92.97	0.14

^aP < 0.05.

^bP < 0.01.

As the Cr, Tbil, WBC, HGB and PLT data showed highly skewed distributions, logarithmic transformations were performed. The INR was also highly skewed, and inverse transformation was used to achieve a sufficient normal distribution. ALB: Albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; Cr: Creatinine; HGB: Hemoglobin; ICGR15: Indocyanine green retention rate at 15 min; INR: International normalized ratio; Na: Sodium; PLT: Platelet; PPG: Portal venous pressure gradient; PVP: Portal venous pressure; Tbil: Total bilirubin; WBC: White blood cell.

Table 3 The areas under the receiver operating characteristic curves of the newly developed Cox model compared to those of the Child-Pugh, model for end-stage liver disease, model for end-stage liver disease-sodium and the Freiburg index of post-transjugular intrahepatic portosystemic shunt survival models

	NDC	Child-Pugh	MELD	MELD-Na	FIPS
Training cohort
6-yr AUC	0.906	0.689	0.649	0.666	0.583
95%CI	0.791-1.000	0.546-0.833	0.493-0.805	0.515-0.817	0.420-0.747
P value vs NDC		0.002^b	0.001^b	0.001^b	< 0.001^b
Validation cohort
6-yr AUC	0.956	0.670	0.661	0.748	0.691
95%CI	0.868-1.000	0.460-0.879	0.400-0.921	0.541-0.955	0.439-0.943
P value vs NDC		0.007^b	0.007^b	0.02^a	0.02^a

^aP < 0.05.

^bP < 0.01.

AUC: Area under the receiver operating characteristic curve; FIPS: Freiburg index of post-transjugular intrahepatic portosystemic shunt survival; MELD: Model for end-stage liver disease; Na: Sodium; NDC: Newly developed Cox.

Citation: Lv YF, Zhu B, Meng MM, Wu YF, Dong CB, Zhang Y, Liu BW, You SL, Lv S, Yang YP, Liu FQ. Development of a new Cox model for predicting long-term survival in hepatitis cirrhosis patients underwent transjugular intrahepatic portosystemic shunts. World J Gastrointest Surg 2024; 16(2): 491-502
URL: https://www.wjgnet.com/1948-9366/full/v16/i2/491.htm
DOI: https://dx.doi.org/10.4240/wjgs.v16.i2.491