Applying LASSO logistic regression for the prediction of biliary complications after ex vivo liver resection and autotransplantation in patients with end-stage hepatic alveolar echinococcosis

Abstract

Background: The purpose of this study was to explore the relevant risk factors associated with biliary complications (BCs) in patients with end-stage hepatic alveolar echinococcosis (HAE) following ex vivo liver resection and autotransplantation (ELRA) and to establish and visualize a nomogram model.

Methods: This study retrospectively analysed patients with end-stage HAE who received ELRA treatment at the First Affiliated Hospital of Xinjiang Medical University between August 1, 2010 and May 10, 2023. The least absolute shrinkage and selection operator (LASSO) regression model was applied to optimize the feature variables for predicting the incidence of BCs following ELRA. Multivariate logistic regression analysis was used to develop a prognostic model by incorporating the selected feature variables from the LASSO regression model. The predictive ability, discrimination, consistency with the actual risk, and clinical utility of the candidate prediction model were evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Internal validation was performed by the bootstrapping method.

Results: The candidate prediction nomogram included predictors such as age, hepatic bile duct dilation, portal hypertension, and regular resection based on hepatic segments. The model demonstrated good discrimination ability and a satisfactory calibration curve, with an area under the ROC curve (AUC) of 0.818 (95% CI 0.7417-0.8958). According to DCA, this prediction model can predict the risk of BCs occurrence within a probability threshold range of 9% to 85% to achieve clinical net benefit.

Conclusions: A prognostic nomogram with good discriminative ability and high accuracy was developed and validated to predict BCs after ELRA in patients with end-stage HAE.

Keywords: Biliary complications; Ex vivo liver resection and autotransplantation; Hepatectomy; Hepatic alveolar echinococcosis; Liver transplantation.

Fig. 1

Selection of the optimum clinical feature variables based on the LASSO binary logistic regression model. A 32 included feature variables were screened and a coefficient profile plot was generated to show the log (lambda) sequence. B Minimum lambda value was determined using tenfold cross-validation. LASSO regression identified four independent variables with nonzero coefficients when the minimum lambda was 0.051

Fig. 2

Nomogram for predicting biliary complications. The nomogram assesses the probability of biliary complications on a scale from 0 to 300. For each predictive factor, draw a vertical line on the evaluation axis and record the corresponding points. Add the points from each predictor to obtain the total score, which corresponds to the predicted probability of major postoperative complications at the bottom of the nomogram

Fig. 3

Calibration curves and receiver operating characteristic (ROC) curve analysis for BCs after ELRA. A Calibration curves of the nomogram model. The x-axis represents the predicted risk of BCs. The y-axis represents the actual diagnosis. B Receiver operating characteristic (ROC) curve analysis for BCs after ELRA.AUC = 0.818(95% CI 0.7417–0.8958)

Fig. 4

Decision curve analysis (DCA) of the nomogram prediction. When the threshold probability is > 9% and < 85%, using this predictive model to identify BCs after ELRA could provide a net clinical benefit

Fig. 5

Postoperative pathological results of the lesion and liver tissue obtained from HAE patients who underwent ELRA surgery. A Dilation of the hepatic duct. The cut end of the bile duct shows invasion by HAE. B HAE with necrosis, brownish-yellow pigment deposition, calcification, and multinucleated giant cell reaction. C Intrahepatic cholestasis and bile duct obstruction occur within the small bile ducts. D Dilation of the intrahepatic bile ducts with partial detachment of the biliary epithelium accompanied by lymphocytic infiltration, microabscess formation, and cholestasis. Lymphocytic infiltration and fibrosis in the hepatic hilum