Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.104884
Revised: February 17, 2025
Accepted: March 10, 2025
Published online: April 27, 2025
Processing time: 83 Days and 16.2 Hours
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.
To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.
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.
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.
The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHT-induced gastrointestinal bleeding.
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.