Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2025; 17(4): 104884
Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.104884
Nomogram for predicting survival after transjugular intrahepatic portosystemic shunt in portal hypertension patients with bleeding
Zhi-Bin Wang, Bing Zhu, Ming-Ming Meng, Yi-Fan Wu, Yu Zhang, Dong-Ze Li, Hua Tian, Fu-Chuan Wang, Yi-Fan Lv, Qiu-Xia Ye, Fu-Quan Liu
Zhi-Bin Wang, Ming-Ming Meng, Yi-Fan Wu, Yu Zhang, Yi-Fan Lv, Qiu-Xia Ye, Fu-Quan Liu, Center for Minimally Invasive Treatment of Liver Diseases, Beijing Shijitan Hospital, Capital Medical University, Beijing 100080, China
Bing Zhu, Dong-Ze Li, Hua Tian, Fu-Chuan Wang, Fu-Quan Liu, Center for Diagnosis and Treatment of Hepatic Vascular Diseases, Fifth Medical Center of Chinese PLA General Hospital, Beijing 100071, China
Author contributions: Wang ZB, Zhu B, Meng MM, and Wu YF collected the data; Zhang Y, Li DZ, and Tian H performed the data analysis; Wang FC, Lv YF, and Ye QX contributed to data interpretation; Wang ZB and Liu FQ drafted the manuscript; Liu FQ supervised the study and revised the manuscript; Wang ZB, Zhu B, Meng MM, Wu YF, Zhang Y, Li DZ, Tian H, Wang FC, Lv YF, Ye QX, and Liu FQ designed the research study; and all authors have read and approved the final version of the manuscript.
Supported by the “14th Five-Year” Talent Training Program of Beijing Shijitan Hospital, Capital Medical University, No. 2023 LJRCLFQ.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Fifth Medical Center of the General Hospital of the People’s Liberation Army, approval No. KY-2023-12-83-1.
Informed consent statement: Since this research project was conducted on the basis of patients’ routine treatment surgeries, without any additional procedures and without causing harm to the patients’ bodies, we adopted the waiver of informed consent in the clinical setting.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The dataset and statistical code are available from the corresponding author, Fu-Quan Liu, at lfuquan@aliyun.com upon reasonable request. Consent for data sharing was not obtained, but the presented data are anonymized, and the risk of identification is low.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fu-Quan Liu, Chief Physician, Professor, Center for Minimally Invasive Treatment of Liver Diseases, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing 100080, China. lfuquan@aliyun.com
Received: January 5, 2025
Revised: February 17, 2025
Accepted: March 10, 2025
Published online: April 27, 2025
Processing time: 83 Days and 16.2 Hours
Abstract
BACKGROUND

Portal hypertension (PHT) is a life-threatening complication of cirrhosis, often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt (TIPS). While TIPS effectively reduces portal pressure, predicting long-term survival remains challenging due to the multifactorial nature of patient outcomes. Accurate survival prediction tools are lacking, and existing models often omit critical factors such as portal vein diameter. This study aimed to develop and validate a nomogram incorporating key clinical and biochemical variables to predict 1-year and 2-year survival following TIPS in PHT patients. We hypothesized that this model would provide improved risk stratification and guide clinical decisions.

AIM

To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.

METHODS

This retrospective cohort study included 848 TIPS-treated PHT patients with gastrointestinal bleeding from two tertiary hospitals (2013-2021). Mortality was the primary endpoint. Predictive variables were selected using least absolute shrinkage and selection operator regression, and a nomogram was developed with Cox regression to predict 1-year and 2-year survival. Model performance was evaluated through receiver operating characteristic curves, calibration plots, and decision curve analysis.

RESULTS

The mean age of the included (848) patients was 53.00 years ± 12.51, where 69.58% were men. Results showed that portal vein diameter, serum creatinine, potassium, and alpha-fetoprotein were the independent predictors of post-TIPS survival. Besides, the model showed strong discriminatory ability (C-index, 0.816 in the training set; 0.827 in the validation set) and good calibration. The area under the curve for 1-year and 2-year survival in the training set were 0.890 [95% confidence interval (CI): 0.802-0.948] and 0.838 (95%CI: 0.803-0.869), respectively. The area under the curve for 1-year and 2-year survival in the validation set were 0.934 (95%CI: 0.815-0.987) and 0.864 (95%CI: 0.811-0.907), respectively.

CONCLUSION

The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHT-induced gastrointestinal bleeding.

Keywords: Portal hypertension; Gastrointestinal hemorrhage; Transjugular Intrahepatic portasystemic shunt; Nomograms; Survival

Core Tip: This study developed and validated a novel nomogram to predict 1-year and 2-year survival in patients undergoing transjugular intrahepatic portosystemic shunt for portal hypertension-induced gastrointestinal bleeding. Key prognostic factors, including portal vein diameter, serum creatinine, potassium, and alpha-fetoprotein, were identified using least absolute shrinkage and selection operator and Cox regression analyses. The model demonstrated excellent discrimination, calibration, and clinical utility across training and validation cohorts. This tool provides an innovative approach to risk stratification and personalized prognosis, offering valuable guidance for clinical decision-making and long-term management of patients receiving transjugular intrahepatic portosystemic shunt.