Development and validation of a nomogram predicting rebleeding in cirrhotic patients with patent transjugular intrahepatic portosystemic shunt

Table 1 Clinical characteristics of patients with variceal rebleeding (n = 45) and the matched non-rebleeding group (n = 135), mean ± SD/n (%)

Variable	EGVB (n = 45)	Non-rebleeding (n = 135)	P value
Male sex	26 (57.8)	79 (58.5)	0.933
Age (years), median (IQR)	54.6 ± 10.1	55 (48-66)	0.562
Aetiology of cirrhosis			0.783
Hepatitis B virus	20 (44.4)	68 (50.4)
Alcoholic liver disease	7 (15.6)	24 (17.8)
Autoimmune	12 (26.7)	27 (20.0)
Others	6 (13.3)	16 (11.9)
CTP score, median (IQR)	7.0 (6.0-8.0)	7.0 (6.0-8.0)	0.202
CTP class			0.244
A	12 (26.7)	53 (39.3)
B	32 (71.1)	79 (58.5)
C	1 (2.2)	3 (2.2)
MELD score, median (IQR)	10.0 (9.0-12.0)	10.0 (8.9-13.0)	0.962
WBC (× 109/L), median (IQR)	2.5 (1.6-3.8)	2.9 (1.9-4.8)	0.0922
PLT (× 109/L), median (IQR)	41.0 (22.0-61.5)	76.0 (58.0-116.0)	< 0.0012,c
ALT (U/L), median (IQR)	19.2 (14.8-26.2)	21.2 (15.0-28.3)	0.682
AST (U/L), median (IQR)	25.6 (19.5-36.2)	28.3 (21.9-37.3)	0.322
ALB (g/L)	32.8 ± 4.4	33.2 ± 5.0	0.661
TB (μmol/L), median (IQR)	20.4 (12.9-26.4)	21.0 (14.8-29.6)	0.462
Cr (mmol/L), median (IQR)	59.0 (48.5-75.5)	59.0 (50.0-74.0)	0.972
PT (second)	14.5 ± 1.4	14.5 ± 2.4	0.991
INR, median (IQR)	1.3 ± 0.2	1.3 (1.2-1.4)	0.652
Pre-PPG (mmHg), median (IQR)	24.7 ± 3.5	21.0 (18.0-23.7)	< 0.0012,c
Post-PPG (mmHg), median (IQR)	11.8 ± 4.0	8.8 (7.9-12.0)	< 0.0012,c
PPG improvement rate (%), median (IQR)	51.9 ± 15.7	56.6 (44.4-63.2)	0.362
Diameter of stent			0.294
6 mm	7 (15.6)	10 (7.4)
7 mm	2 (4.4)	4 (3.0)
8 mm	36 (80.0)	120 (88.9)
10 mm	0 (0)	1 (0.7)
Length of spleen (cm), median (IQR)	20.3 ± 3.7	15.8 (13.6-18.3)	< 0.0012,c
Width of spleen (cm)	15.4 ± 2.5	12.7 ± 2.5	< 0.0011,c
Thickness of spleen (cm), median (IQR)	5.6 ± 1.5	5.6 (4.8-6.6)	0.781
Volume of spleen (cm3), median (IQR)	1019 (743-1354)	749 (454-924)	< 0.0012,c
Diameter of splenic vein (mm), median (IQR)	14.5 ± 3.1	12.0 (10.0-13.3)	< 0.0012,c
Spleen vein velocity (cm/second), median (IQR)	30.8 (26.8-37.1)	33.3 (28.2-37.5)	0.282
Flow volume of splenic vein (L/minute), median (IQR)	3.0 (2.1-4.5)	2.3 (1.4-3.2)	< 0.0012,c
Post 1 month WBC (× 109/L), median (IQR)	2.6 (1.6-3.6)	3.3 (2.2-4.4)	0.0142,a
Post 1 month PLT (× 109/L), median (IQR)	49 (32-67)	65 (39-100)	0.0092,b
Post 1 month velocity of blood flow in stent (cm/second), median (IQR)	199 (179-214)	189 (175-204)	0.0642
Post 12 months velocity of blood flow in stent (cm/second), median (IQR)	192 ± 33	182 (171-199)	0.0762
Post 12 months WBC (× 109/L), median (IQR)	2.7 (1.9-3.6)	3.7 (2.6-4.3)	< 0.0012,c
Post 12 months PLT (× 109/L), median (IQR)	38 (32-72)	77 (48-113)	< 0.0012,c
Portal vein thrombosis			0.124
No	31 (68.9)	85 (63.0)
Partial	12 (26.7)	49 (36.3)
Completely occluded or cavernoma	2 (4.4)	1 (0.7)
Gastrorenal shunt	6 (13.3)	14 (10.4)	0.583

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

¹Independent-sample t-test.

²Mann-Whitney U test.

³χ² test.

⁴Fisher’s exact test.

EGVB: Oesophagogastric variceal rebleeding; IQR: Interquartile range; CTP: Child-Turcotte-Pugh; MELD: Model for end-stage liver disease; WBC: White blood cell; PLT: Platelet; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALB: Albumin; TB: Total bilirubin; Cr: Creatinine; PT: Prothrombin time; INR: International normalized ratio; PPG: Portal pressure gradient.

Table 2 Logistic regression analysis of risk factors for rebleeding

Variable	β	SE	P value	Exp (B)	VIF
Length of spleen (cm)	0.163	0.08	0.047	1.177 (1.002, 1.381)	2.551
Width of spleen (cm)	0.354	0.14	0.010	1.425 (1.088, 1.866)	2.066
Volume of spleen (cm3)	0.001	0.00	0.108	0.998 (0.996, 1.000)	1.541
Diameter of splenic vein (mm)	0.406	1.71	0.017	1.501 (1.074, 2.097)	4.432
Flow volume of splenic vein (L/minute)	0.366	0.24	0.123	0.694 (0.435, 1.104)	3.587
Pre-PPG (mmHg)	0.167	0.05	0.001	1.182 (1.067, 1.309)	1.105
PLT	0.021	0.01	0.017	0.980 (0.963, 0.996)	1.170

PLT: Platelet; VIF: Variance inflation factor; PPG: Portal pressure gradient.