Objective To investigate the influence factors of liver cirrhosis combined with upper gastrointestinal hemorrhage (UGB) and the predictive value of fibrinogen (Fbg),D-dimer (D-D),interleukin-6 (IL-6) on bleeding risk. Methods A total of 82 patients with cirrhosis combined with UGB treated in our hospital from April 2021 to May 2023 were selected as the bleeding group,while 104 patients with simple cirrhosis without UGB as the non-bleeding group. Kendall's tau-b method was used to analyze the correlation between serum Fbg,D-D,IL-6 and clinical features of patients with cirrhosis. Logistic regression was used to analyze the risk factors of UGB in patients with cirrhosis. Receiver operating characteristic (ROC) curve was used to analyze the area under the curve (AUC) value,sensitivity and specificity of Fbg,D-D and IL-6 and combined prediction index to predict UGB in patients with cirrhosis. Results There were statistically significant differences in drinking history,Child-Pugh grade,esophageal varices degree,portal vein diameter,spleen thickness,albumin,ascites and gastric fundus varices (P<0.05). Serum Fbg in the bleeding group was lower than that in the non-bleeding group,while D-D and IL-6 were higher than that in the non-bleeding group (P<0.05). Kendall's tau-b correlation analysis showed that Fbg was negatively correlated with Child-Pugh grade,and the degree of esophageal varices was positively correlated with D-D and IL-6 (P<0.05). Logistic regression analysis showed that drinking history,spleen thickness>40 mm,gastric varices,decreased Fbg content and increased D-D and IL-6 levels were risk factors for UGB in patients with liver cirrhosis (P<0.05). ROC curve analysis showed that the AUC values of Fbg,D-D,IL-6,the combination of the three and the nomogram prediction model for predicting UGB in patients with liver cirrhosis were 0.728,0.745,0.732,0.916 and 0.948,respectively,which all had certain predictive value for UGB in patients with liver cirrhosis,but the nomogram prediction model was higher. When the cut-off value was taken,the sensitivity and specificity of the nomogram prediction model were 86.60％ and 86.50％,respectively. Bootstrap internal validation (B=1000) showed that the Bias-corrected curve basically coincided with the Ideal curve,suggesting that the prediction efficiency of the model was good and relatively stable. Conclusion Drinking history,spleen thickness>40 mm,gastric varices,decreased Fbg content and increased D-D and IL-6 levels are the risk factors of UGB in patients with liver cirrhosis,indicating that the identified factors and the nomogram prediction model could be valuable tools in clinical practice for assessing the risk of UGB in cirrhotic patients.
万方数据
维普
