Nomogram based on spleen volume expansion rate predicts esophagogastric varices bleeding risk in patients with hepatitis B liver cirrhosis

Abstract

Background: We aimed to explore the risk factors for hemorrhage of esophagogastric varices (EGVs) in patients with hepatitis B cirrhosis and to construct a novel nomogram model based on the spleen volume expansion rate to predict the risk of esophagogastric varices bleeding.

Methods: Univariate and multivariate logistic regression analysis was used to analyze the risk factors for EGVs bleeding. Nomograms were established based on the multivariate analysis results. The predictive accuracy of the nomograms was assessed using the area under the curve (AUC or C-index) of the receiver operating characteristic (ROC) and calibration curves. Decision curve analysis was used to determine the clinical benefit of the nomogram. We created a nomogram of the best predictive models.

Results: A total of 142 patients' hepatitis B cirrhosis with esophagogastric varices were included in this study, of whom 85 (59.9%) had a history of EGVs bleeding and 57 (40.1%) had no EGVs bleeding. The spleen volume expansion rate, serum sodium levels (mmol/L), hemoglobin levels (g/L), and prothrombin time (s) were independent predictors for EGVs bleeding in patients with hepatitis B liver cirrhosis (P < 0.05). The above predictors were included in the nomogram prediction model. The area under the ROC curve (AUROC) of the nomogram was 0.781, the C-index obtained by internal validation was 0.757, and the calibration prediction curve fit well with the ideal curve. The AUROCs of the PLT-MELD and APRI were 0.648 and 0.548, respectively.

Conclusion: In this study, a novel nomogram for predicting the risk of EGVs bleeding in patients with hepatitis B cirrhosis was successfully constructed by combining the spleen volume expansion rate, serum sodium levels, hemoglobin levels, and prothrombin time. The predictive model can provide clinicians with a reference to help them make clinical decisions.

Keywords: esophagogastric varices bleeding; hepatitis B cirrhosis; liver and spleen volume; nomogram; serum sodium.

Figure 1

Liver and spleen volume, as measured by CT, in a 44-year-old male who has had hepatitis B cirrhosis for 20 years.

Figure 2

The nomogram for predicting the bleeding risk of esophagogastric varices in patients with hepatitis B cirrhosis. A 59-year-old male patient with hepatitis B cirrhosis for 20 years. The total score and the density map of SVER, SNA, Hb, and PT are shown. The importance of each variable is ordered according to the standard deviation on the nomogram scale. To use the nomogram, individual patient-specific points (red dots) are located on each variable axis. Mark the red dots on the points axis to determine the number of points each variable received; the sum of these points (335) lies on the total points axis. Draw a line down to the probability axis to identify the probability of esophagogastric variceal bleeding (89.7%).

Figure 3

(A) Area under receiver operating characteristic (AUROC) of nomogram for predicting esophagogastric variceal bleeding with hepatitis B cirrhosis. (B) The calibration curves for predicting esophagogastric variceal bleeding with hepatitis B cirrhosis.

Figure 4

Area under receiver operating characteristic (ROC) comparison of nomogram, PLT-MELD and APRI.

Figure 5

Decision curves for prediction of the net benefit of the constructed nomogram, PLT-MELD and APRI. Gray line: net benefit of a strategy of treating all patients with esophagogastric varices in hepatitis B cirrhosis. Horizontal black line: net benefit of treating no patients with esophagogastric varices in hepatitis B cirrhosis. Colored lines: net benefit of a strategy of treating patients according to nomogram, PLT-MELD and APRI. Red line: screen based on the nomogram; green line: screen based on the PLT-MELD; blue line: screen based on the APRI.