Clinical online nomogram for predicting prognosis in recurrent hepatolithiasis after biliary surgery: A multicenter, retrospective study

Table 1 Preoperative clinical characteristics of patients with recurrent hepatolithiasis after biliary surgery

Characteristic	Training cohort	Validation cohort	P value
	N = 299	N = 142
Sex			0.785
Male	93 (31.1%)	46 (32.4%)
Female	206 (68.9%)	96 (67.6%)
Age (yr)			0.613
< 60	153 (51.2%)	69 (48.6%)
≥ 60	146 (48.8%)	73 (51.4%)
BMI	21.72 ± 2.87	22.19 ± 2.96	0.317
Abdominal pain			0.204
No	39 (13.0%)	25 (17.6%)
Yes	260 (87.0%)	117 (82.4%)
Fever			0.162
No	175 (58.5%)	93 (65.5%)
Yes	124 (41.5%)	49 (34.5%)
Jaundice			0.060
No	227 (75.9%)	119 (83.8%)
Yes	72 (24.1%)	23 (16.2%)
Number of previous surgeries			0.374
1	199 (66.6%)	101 (71.1%)
2	57 (19.1%)	29 (20.4%)
3	33 (11.0%)	9 (6.3%)
≥ 4	10 (3.3%)	3 (2.1%)
Previous hepatectomy			0.293
No	238 (79.6%)	119 (83.8%)
Yes	61 (20.4%)	23 (16.2%)
Previous cholangioenterostomy			0.057
No	257 (86.0%)	131 (92.3%)
Yes	42 (14.0%)	11 (7.7%)
NLR			0.453
< 2.462	188 (62.9%)	84 (59.2%)
≥ 2.462	111 (37.1%)	58 (40.8%)
< PLR			0.804
173.74	237 (79.3%)	114 (80.3%)
≥ 173.74	62 (20.7%)	28 (19.7%)
AGR			0.430
> 1.5	104 (34.8%)	44 (31.0%)
≤ 1.5	195 (65.2%)	98 (69.0%)
TB (μmol/L)			0.262
< 34.2	249 (83.3%)	112 (78.9%)
≥ 34.2	50 (16.7%)	30 (21.1%)
ALT (IU/L)			0.474
< 50	181 (60.5%)	91 (64.1%)
≥ 50	118 (39.5%)	51 (35.9%)
AST (IU/L)			0.522
< 40	180 (60.2%)	90 (63.4%)
≥ 40	119 (39.8%)	52 (36.6%)
ALP (IU/L)			0.053
< 200	180 (60.2%)	99 (69.7%)
≥ 200	119 (39.8%)	43 (30.3%)
GGT (IU/L)			0.182
< 150	146 (48.8%)	79 (55.6%)
≥ 150	153 (51.2%)	63 (44.4%)
HBsAg			0.107
Negative	271 (90.6%)	135 (95.1%)
Positive	28 (9.4%)	7 (4.9%)
CA19-9 (U/mL)			0.428
< 34	208 (69.6%)	104 (73.2%)
≥ 34	91 (30.4%)	38 (26.8%)
Hepatolithiasis research group			0.089
I	19 (6.4%)	18 (12.7%)
II	152 (50.8%)	67 (47.2%)
III	100 (33.4%)	49 (34.5%)
IV	28 (9.4%)	8 (5.6%)
Tsunoda classification			0.052
I	17 (5.7%)	19 (13.4%)
II	166 (55.5%)	74 (52.1%)
III	100 (33.4%)	43 (30.3%)
IV	16 (5.4%)	6 (4.2%)
Chinese medical association			0.295
I	238 (79.6%)	123 (86.6%)
IIa	30 (10.0%)	8 (5.6%)
IIb	25 (8.4%)	8 (5.6%)
IIc	6 (2.0%)	3 (2.1%)

BMI: Body mass index; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; AGR: Albumin-to-globulin ratio; TB: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: γ-glutamyl transpeptidase; HbsAg: Hepatitis B surface antigen; CA19-9: Carbohydrate antigen 19-9.

Table 2 Intra- and postoperative clinical characteristics of patients with recurrent hepatolithiasis after biliary surgery

Characteristic	Training cohort	Validation cohort	P value
	N = 299	N = 142
Operation duration (h)			0.168
≤ 2	66 (22.1%)	38 (26.8%)
2-4	122 (40.8%)	64 (45.1%)
> 4	111 (37.1%)	40 (28.2%)
Liver cirrhosis			0.690
No	261 (87.3%)	122 (85.9%)
Yes	38 (12.7%)	20 (14.1%)
Hepatic atrophy			0.068
No	124 (41.5%)	72 (50.7%)
Yes	175 (58.5%)	70 (49.3%)
Intrahepatic stenosis			0.182
No	238 (79.6%)	105 (73.9%)
Yes	61 (20.4%)	37 (26.1%)
Extrahepatic stones			0.813
No	64 (21.4%)	29 (20.4%)
Yes	235 (78.6%)	113 (79.6%)
Hepatectomy			0.084
No	101 (33.8%)	60 (42.3%)
Yes	198 (66.2%)	82 (57.7%)
Bilateral hepatolithiasis			0.074
No	238 (79.6%)	123 (86.6%)
Yes	61 (20.4%)	19 (13.4%)
Drainage mode			0.125
External T tube drainage	205 (68.6%)	109 (76.8%)
Cholangioenterostomy	44 (14.7%)	19 (13.4%)
Combined drainage	50 (16.7%)	14 (9.9%)
Function of the SO			0.521
Normal	130 (43.5%)	72 (50.7%)
Dysfunction	62 (20.7%)	27 (19.0%)
Nonfunctional	83 (27.8%)	32 (22.5%)
Resected	24 (8.0%)	11 (7.7%)
Intraoperative bleeding (mL)			0.465
< 400	285 (95.3%)	133 (93.7%)
≥ 400	14 (4.7%)	9 (6.3%)
Blood transfusion			0.112
No	258 (86.3%)	130 (91.5%)
Yes	41 (13.7%)	12 (8.5%)
TB after operation (μmol/L)			0.131
< 34.2	232 (77.6%)	119 (83.8%)
≥ 34.2	67 (22.4%)	23 (16.2%)
Bile culture			0.471
Negative	196 (65.6%)	98 (69.0%)
Positive	103 (34.4%)	44 (31.0%)
Clavien-Dindo classification			0.784
< III	286 (95.7%)	135 (95.1%)
≥ III	13 (4.3%)	7 (4.9%)
Hospitalization expenses	48272 ± 22537	44933 ± 25354	0.164
Immediate clearance			0.298
Yes	229 (76.6%)	115 (81.0%)
No	70 (23.4%)	27 (19.0%)
Final clearance			0.399
Yes	283 (94.6%)	137 (96.5%)
No	16 (5.4%)	5 (3.5%)

SO: Sphincter of Oddi; TB: Total bilirubin.

Table 3 Univariable and multivariable logistic regression analyses of the risk factors for a poor prognosis in patients with recurrent hepatolithiasis

Variable	Univariable analysis		Multivariable analysis
	P value	OR (95%CI)	P value	OR (95%CI)
Sex: Female/Male	0.328	1.311 (0.762-2.257)
Age (yr): ≥ 60/< 60	0.603	1.139 (0.697-1.862)
BMI	0.068	0.921 (0.843-1.006
Abdominal pain: Yes/No	0.066	0.525 (0.264-1.043)
Fever: Yes/No	0.083	1.551 (0.945-2.547)
Jaundice: Yes/No	0.406	1.270 (0.724-2.230)
Previous operation times
2 times/1 time	0.384	1.337 (0.695-2.571)	0.299	1.451 (0.719-2.932)
3 times/1 time	< 0.001	4.840 (2.241-10.454)	< 0.001	4.573 (2.015-10.378)
≥ 4 times/1 time	0.005	7.340 (1.827-29.498)	0.018	5.741 (1.347-24.470)
Previous hepatectomy: Yes/No	0.026	1.936 (1.082-3.463)	0.144	1.642 (0.845-3.190)
Previous cholangioenterostomy: Yes/No	0.455	1.299 (0.654-2.577)
NLR: ≥ 2.462/< 2.462	0.001	2.334 (1.410-3.863)	0.022	1.915 (1.099-3.337)
PLR: ≥ 173.74/< 173.74	0.069	1.714 (0.959-3.065)
AGR: ≤ 1.5/> 1.5	0.002	2.459 (1.393-4.338)	0.033	1.949 (1.056-3.595)
TB (μmol/L): ≥ 34.2/< 34.2	0.381	1.330 (0.703-2.518)
ALT (IU/L): ≥ 50/< 50	0.664	1.117 (0.677-1.843)
AST (IU/L): ≥ 40/< 40	0.169	1.418 (0.862-2.333)
ALP (IU/L): ≥ 200/< 200	0.060	1.613 (0.981-2.654)
GGT (IU/L): ≥ 150/< 150	0.464	1.202 (0.735-1.967)
HBsAg: Positive/Negative	0.791	0.890 (0.377-2.103)
CA19-9 (U/mL): ≥ 34/< 34	0.058	1.656 (0.984-2.787)
Operation duration (h)
2-4/≤ 2	0.803	1.085 (0.572-2.057)
> 4/≤ 2	0.497	0.794 (0.408-1.545)
Liver cirrhosis: Yes/No	0.049	2.008 (1.004-4.016)	0.478	1.343 (0.595-3.034)
Hepatic atrophy: Yes/No	0.469	0.833 (0.507-1.368)
Intrahepatic stenosis: Yes/No	0.054	1.772 (0.989-3.176)
Extrahepatic stones: Yes/No	0.481	0.810 (0.450-1.456)
Hepatectomy: Yes/No	0.019	0.543 (0.326-0.904)	0.211	0.692 (0.389-1.232)
Bilateral hepatolithiasis: Yes/No	0.011	2.114 (1.183-3.775)	0.038	1.965 (1.039-3.717)
Drainage mode
Cholangioenterostomy/External T tube drainage	0.292	0.663 (0.308-1.425)
Combined drainage/External T tube drainage	0.325	1.381 (0.726-2.629)
Function of the SO
Dysfunction/Normal	0.760	1.110 (0.567-2.173)
Nonfunctional/Normal	0.051	1.791 (0.997-3.219)
Resected/Normal	0.845	0.905 (0.332-2.464)
Intraoperative bleeding (mL): ≥ 400/< 400	0.682	1.264 (0.412-3.883)
Blood transfusion: Yes/No	0.053	1.946 (0.993-3.815)
TB after operation (μmol/L): ≥ 34.2/< 34.2	0.908	1.035 (0.576-1.862)
Bile culture: Positive/Negative	0.384	1.255 (0.753-2.093)
Clavien-Dindo classification: ≥ III/< III	0.541	1.430 (0.455-4.494)
Hospitalization expenses	0.913	1.000 (1.000-1.000)
Immediate clearance: No/Yes	< 0.001	3.271 (1.874-5.711)	0.005	2.398 (1.304-4.409)
Final clearance: No/Yes	0.030	3.098 (1.117-8.595)	0.558	1.448 (0.420-4.996)

BMI: Body mass index; NLR: Neutrophil-to-lymphocyte ratio; PLR: Platelet-to-lymphocyte ratio; AGR: Albumin-to-globulin ratio; TB: Total bilirubin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: γ-glutamyl transpeptidase; HbsAg: Hepatitis B surface antigen; CA19-9: Carbohydrate antigen19-9; SO: Sphincter of Oddi; OR: Odds ratio; CI: Confidence interval.