目的 建立并验证肝硬化静脉曲张患者上消化道大出血风险的预测模型.方法 本研究回顾性收集宁夏医科大学总医院急诊室2019年10月至2022年10月期间收治的肝硬化食管胃底静脉曲张破裂出血患者的临床资料.通过随机数字表法按7:3比例分为建模组和验证组.观察指标为入院24 h是否发生上消化道大出血.运用Logistic回归模型中的预测因素构建肝硬化静脉曲张患者上消化道大出血风险的预测模型,并使用受试者工作特征曲线下面积(area under the curve,AUC)、校正曲线和决策曲线分析对预测模型的鉴别能力、准确性和临床实用性进行评估.结果 共纳入305例患者,建模与验证组分别为215例、90例,两组临床资料具有可比性.多因素 Logistic 回归发现,收缩压(OR=0.918,95％CI:0.860～0.980,P=0.010)、MAP(ASH)评分(OR=1.993,95％CI:1.017～3.907,P=0.045)、Child-Pugh 评 分(OR=1.999,95％CI:1.139～3.510,P=0.016)及终末期肝病模型(model for end-stage liver disease,MELD)(OR=1.398,95％CI:1.037～1.886,P=0.028)是肝硬化静脉曲张患者发生上消化道大出血的独立影响因素.建模组预测模型的AUC为 0.936(95％CI:0.895～0.976),验证组预测模型的 AUC 为 0.891(95％CI:0.807～0.975),该预测模型具有良好的鉴别、校准和临床应用价值.结论 收缩压、MAP(ASH)评分、Child-Pugh评分及终末期肝病模型构建的预测模型有助于急诊室早期预测肝硬化静脉曲张患者发生上消化道大出血的风险.
A prediction model for the risk of major upper gastrointestinal bleeding in patients with cirrhosis varices
Objective To establish and validate a prediction model for the risk of major upper gastrointestinal bleeding in patients with varices of liver cirrhosis.Method This study retrospectively collected the clinical data of patients with esophageal and gastric variceal bleeding who were admitted to the emergency department of Ningxia Medical University General Hospital from October 2019 to October 2022.The patients were divided into modeling group and validation group according to the ratio of 7:3 by random number table method.The observation index was whether the upper gastrointestinal bleeding occurred within 24 hours after admission.The predictors in the logistic regression model were used to construct a prediction model for the risk of major upper gastrointestinal bleeding in patients with varices with liver cirrhosis,and the area under the receiver operating characteristic curve(AUC),the correction curve and the decision curve were analyzed to evaluate the discriminatory ability,accuracy and clinical utility of the prediction model.Results A total of 305 patients were included,including 215 and 90 in the modeling and validation groups,respectively,and the clinical data of the two groups were comparable.Multivariate logistic regression showed that systolic blood pressure(OR=0.918,95％CI:0.860-0.980,P=0.010),MAP(ASH)score(OR=1.993,95％CI:1.017-3.907,P=0.045),Child-Pugh score(OR=1.999,95％CI:1.139-3.510,P=0.016)and model for end-stage liver disease(MELD)(OR=1.398,95％CI:1.037-1.886,P=0.028)were independent influencing factors for the occurrence of upper gastrointestinal bleeding in patients with liver cirrhosis varices.The AUC of the prediction model in the modeling group was 0.936(95％CI:0.895-0.976),and that of the prediction model in the validation group was 0.891(95％CI:0.807-0.975),the prediction model had good identification,calibration,and clinical application value.Conclusions Systolic blood pressure,MAP(ASH)score,Child-Pugh score,and prediction models constructed by end-stage liver disease models are helpful for early prediction of the risk of upper gastrointestinal bleeding in patients with cirrhosis varices in the emergency department.
CirrhosisVaricose veinsMassive hemorrhage of digestive tractPrediction model
万方数据
维普
