Nomogram for prediction of six-month mortality following endovascular treatment of delayed post-pancreatectomy hemorrhage

Abstract

BACKGROUND

Delayed post-pancreatectomy hemorrhage (PPH) is life-threatening, and endovascular interventions show promise. This retrospective study aimed to evaluate endovascular treatment outcomes for delayed PPH and identify mortality risk factors.

AIM

To conduct a single-center retrospective study of 88 patients with delayed PPH to systematically evaluate the clinical efficacy of endovascular treatment, identify independent risk factors for six-month mortality, and propose and validate a predictive model for individualized management of high-risk patients.

METHODS

This retrospective analysis included 88 patients with delayed PPH treated by endovascular intervention. Patients were stratified into survival (n = 64) and mortality (n = 24) groups. Clinical and procedural variables were assessed using univariate and multivariate logistic regression. Significant predictors were incorporated into a prognostic nomogram. Model performance was assessed through discrimination (area under the receiver operating characteristic curve), calibration, and decision curve analysis.

RESULTS

Technical and clinical success rates were 92.0% and 60.2%, respectively. The overall six-month mortality rate was 27.3% (24/88). Independent predictors of mortality included advanced age, prolonged operative time, shorter hospital stay, intra-abdominal infection, coagulation dysfunction, common hepatic artery bleeding, and failure to achieve clinical success. The nomogram demonstrated excellent discrimination (area under the receiver operating characteristic curve = 0.943), with good calibration and favorable net benefit on decision curve analysis.

CONCLUSION

We proposed and validated a predictive nomogram for six-month mortality following endovascular treatment for delayed PPH. The model facilitates individualized risk stratification and may guide clinical decision-making. Early identification of high-risk patients - particularly older individuals or those with infection or coagulopathy - and prompt, personalized intervention may improve outcomes in this high-risk population.

Keywords: Delayed post-pancreatectomy hemorrhage; Endovascular intervention; Pancreaticoduodenectomy; Mortality; Clinical outcome; Nomogram

Core Tip: This retrospective study is the first to establish and validate a nomogram for predicting six-month mortality in patients with delayed post-pancreatectomy hemorrhage treated with endovascular intervention. By retrospectively analyzing 88 cases, several independent prognostic factors were identified, including advanced age, prolonged operative time, shorter in-hospital days, intra-abdominal infection, coagulation abnormalities, and clinical failure. Notably, bleeding from the common hepatic artery was confirmed as an independent predictor of mortality. The proposed nomogram demonstrated good discrimination and clinical applicability, offering a practical tool for individualized risk stratification and management in high-risk post-pancreatectomy hemorrhage patients.