Risk factors for unplanned readmission after transjugular intrahepatic portosystemic shunt in cirrhotic patients with esophagogastric variceal bleeding and construction of a nomogram model
- VernacularTitle:肝硬化食管胃底静脉曲张破裂出血患者经颈静脉肝内门体分流术后非计划再入院的危险因素分析及列线图模型构建
- Author:
Qin YIN
1
;
Zhaorong WU
1
;
Feng ZHANG
1
;
Chunyan JIN
1
;
Yanping CAO
1
;
Jiangqiang XIAO
1
;
Yuzheng ZHUGE
1
;
Qian WANG
1
Author Information
- Publication Type:Journal Article
- Keywords: Liver Cirrhosis; Portasystemic Shunt， Transjugular Intrahepatic; Risk Factors
- From: Journal of Clinical Hepatology 2024;40(9):1796-1801
- CountryChina
- Language:Chinese
- Abstract: ObjectiveTo investigate the risk factors for unplanned readmission within 30 days after discharge in cirrhotic patients with esophagogastric variceal bleeding undergoing transjugular intrahepatic portosystemic shunt （TIPS）， and to construct a nomogram predictive model. MethodsA total of 241 cirrhotic patients who underwent TIPS due to esophagogastric variceal bleeding in Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2020 to June 2023 were enrolled as subjects， and unplanned readmission within 30 days was analyzed. According to the presence or absence of unplanned readmission， they were divided into readmission group with 36 patients and non-readmission group with 198 patients， and related clinical data were collected from all patients. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. A logistic regression analysis was used to identify independent risk factors for unplanned readmission. A nomogram prediction model was constructed， and the receiver operating characteristic （ROC） curve was plotted to assess its discriminatory ability for unplanned readmission； the calibration curve was plotted to evaluate the consistency of the nomogram model in predicting unplanned readmission； the ResourceSelection package of R language was used for the Hosmer-Lemeshow goodness-of-fit test to evaluate the degree of fitting of the mode； the decision curve analysis was used to investigate the practicality of the model. ResultsAge （odds ratio ［OR］=2.664， 95% confidence interval ［CI］： 1.139 — 6.233， P<0.05）， CTP score （OR=1.655， 95%CI： 1.098 — 2.495， P<0.05）， and blood ammonia （OR=1.032， 95%CI： 1.016 — 1.048， P<0.05） were independent risk factors for unplanned readmission within 30 days after discharge in the patients undergoing TIPS. The multivariate analysis showed that for the nomogram predictive model constructed in this study， repeated sampling for 1 000 times using the Bootstrap method was performed for internal validation， and the area under the ROC curve was 0.773， which was significantly higher than that of age （0.582）， CTP score （0.675）， and blood ammonia （0.641）. The calibration curve showed good consistency between the probability of unplanned readmission predicted by the nomogram model and the actual probability， and the Hosmer-Lemeshow goodness-of-fit test showed good degree of fitting （c2=5.647 3， P=0.686 7）. ConclusionAge， CTP score， and blood ammonia are independent risk factors for unplanned readmission within 30 days after TIPS， and the nomogram prediction model constructed based on these factors can help to predict the risk of unplanned readmission in TIPS patients and provide an accurate decision-making basis for early prevention.
