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

Table 1 Variance inflation factor values for variables in multivariate analysis

Variable	VIF
Age	1.38
In-hospital days	1.28
Operating duration	1.35
Intra-abdominal infection	1.22
APTT	2.71
INR	2.53
Coagulopathy	1.87
Clinical success	1.35
CHA bleeding	1.05

Variance inflation factor values < 5 indicate no significant multicollinearity among the variables included in the multivariate regression model. VIF: Variance inflation factor; APTT: Activated partial thromboplastin time; INR: International normalized ratio; CHA: Celiac hepatic artery.

Table 2 Patient demographics and perioperative characteristics stratified by survival outcome, mean ± SD/n (%)/median (interquartile range)

Characteristic	Total (n = 88)	PPH survival group (n = 64)	PPH mortality group (n = 24)	P value
Age, years	64.0 ± 9.9	62.6 ± 9.9	67.6 ± 9	0.028
Gender				0.218
Male	56 (63.6)	38 (59.4)	18 (75)
Female	32 (36.4)	26 (40.6)	6 (25)
Hypertension	43 (48.9)	35 (54.7)	8 (33.3)	0.095
Diabetes	11 (12.5)	5 (7.8)	6 (25)	0.063
In-hospital days	45 (36.5-63.25)	50 (38-64.25)	39 (24.25-51.5)	0.01
Pathology diagnosis				0.223
PDCA	23 (26.1)	16 (25.0)	7 (29.2)
CBD cancer	34 (38.6)	21 (32.8)	13 (54.2)
Ampullary cancer	5 (5.7)	4 (6.2)	1 (4.2)
Duodenal cancer	13 (14.8)	10 (15.6)	3 (12.5)
Other malignancies	7 (8.0)	7 (10.9)	0 (0)
Other benign disease	6 (6.8)	6 (9.4)	0 (0)
Preoperative total bilirubin (mmol/L)	62.1 (19.8-127.2)	62.5 (19-131.1)	62.0 (20.7-119.5)	0.892
Preoperative direct bilirubin (mmol/L)	42.5 (14.2-101.1)	48.0 (13.6-108)	39.5 (17.1-72.2)	0.818
Operating duration (minutes)	655.0 (540.0-753.8)	610.0 (498.8-727.5)	697.5 (611.2-768.8)	0.065
Perioperative complications
POPF	58 (65.9)	38 (59.4)	20 (83.3)	0.044
Gastrointestinal fistula	5 (5.7)	4 (6.2)	1 (4.2)	1
Bile leakage	5 (5.7)	9 (14.1)	5 (20.8)	0.516
Intra-abdominal infection	43 (48.9)	27 (42.2)	16 (66.7)	0.056
Hemorrhage details
Bleeding latency, days	15 (11-23)	15 (10-23)	17.5 (13.2-19.5)	0.422
Hemoglobin concentration(g/L)	74.7 ± 15.7	75.2 ± 14.8	73.5 ± 18.3	0.688
PLT (109/L)	250.6 ± 101.9	262.2 ± 90.8	219.5 ± 123.7	0.133
APTT (s)	32.8 (27.6-41.8)	32.3 (26.5-39.3)	37.1 (30.2-49.8)	0.037
INR	1.2 (1.1-1.3)	1.1 (1.1-1.2)	1.3 (1.2-1.7)	< 0.001
Coagulopathy	31 (35.2)	17 (26.6)	14 (58.3)	0.011
Severity of PPH				0.088
Grade B	36 (40.9)	30 (46.9)	6 (25)
Grade C	52 (59.1)	34 (53.1)	18 (75)

PDCA: Pancreatic ductal adenocarcinoma; CBD: Common bile duct; POPF: Postoperative pancreatic fistula; PLT: Platelet count; APTT: Activated partial thromboplastin time; INR: International normalized ratio; PPH: Post-pancreatectomy hemorrhage.

Table 3 Angiographic findings, embolization strategies, and clinical outcomes in patients with delayed post-pancreatectomy hemorrhage, n (%)

Characteristic	Total	PPH survival group	PPH mortality group	P value
Bleeding site on angiogram	92 (100)	68 (73.9)	24 (26.1)
Negative	18 (20.5)	15 (23.4)	3 (12.5)	0.376
Common hepatic artery	23 (26.1)	13 (20.3)	10 (41.7)	0.057
Stump of gastroduodenal artery	16 (18.2)	11 (17.2)	5 (20.8)	0.759
SMA	8 (9.1)	7 (10.9)	1 (4.2)	0.438
Proper hepatic artery	13 (14.8)	10 (15.6)	3 (12.5)	1
Right hepatic artery	3 (3.4)	2 (3.1)	1 (4.2)	1
Left hepatic artery	4 (4.5)	3 (4.7)	1 (4.2)	1
Left gastric artery	5 (5.7)	5 (7.8)	0 (0)	0.317
Splenic artery	1 (1.1)	1 (1.6)	0 (0)	1
Pancreaticoduodenal artery	1 (1.1)	1 (1.6)	0 (0)	1
Embolism site on angiogram	92 (100)	68 (73.9)	24 (26.1)
Conservative treatment	15 (17)	13 (20.3)	2 (8.3)	0.222
Common hepatic artery	47 (53.4)	30 (46.9)	17 (70.8)	0.056
Stump of gastroduodenal artery	1 (1.1)	1 (1.6)	0 (0)	1
SMA	7 (8)	7 (10.9)	0 (0)	0.183
Proper hepatic artery	7 (8)	5 (7.8)	2 (8.3)	1
Right hepatic artery	3 (3.4)	2 (3.1)	1 (4.2)	1
Left hepatic artery	3 (3.4)	2 (3.1)	1 (4.2)	1
Left gastric artery	7 (8)	6 (9.4)	1 (4.2)	0.669
Splenic artery	1 (1.1)	1 (1.6)	0 (0)	1
Pancreaticoduodenal artery	1 (1.1)	1 (1.6)	0 (0)	1
Angiographic sign	103 (100)	73 (70.9)	30 (29.1)
Negative	16 (18.2)	15 (23.4)	1 (4.2)	0.059
Contrast medium overflow	31 (35.2)	17 (26.6)	14 (58.3)	0.011
Pseudoaneurysm	28 (31.8)	20 (31.2)	8 (33.3)	1
Vessel stenosis	18 (20.5)	12 (18.8)	6 (25)	0.559
Stump of gastroduodenal artery	8 (9.1)	7 (10.9)	1 (4.2)	0.438
Suspicious of contrast agent staining	2 (2.3)	2 (3.1)	0 (0)	1
Onset symptom of hemorrhage	126	88	38
Pseudoaneurysm detected on postoperative follow-up CT	3 (3.4)	3 (4.7)	0 (0)	0.559
Melena or/and hematemesis	33 (37.5)	24 (37.5)	9 (37.5)	1
Sentinel bleeding	56 (63.6)	41 (64.1)	15 (62.5)	1
Hemorrhagic shock	34 (38.6)	20 (31.2)	14 (58.3)	0.027
Strategy of embolization	88	64	24	0.18
Targeted embolization	58 (65.9)	39 (60.9)	19 (79.2)
Empiric embolization	11 (12.5)	8 (12.5)	3 (12.5)
No embolization	19 (21.6)	17 (26.6)	2 (8.3)
Embolic material	74	51	23
Coils	60 (68.2)	40 (62.5)	20 (83.3)	0.075
Stent	8 (9.1)	7 (10.9)	1 (4.2)	0.438
Gelatin sponges	4 (4.5)	3 (4.7)	1 (4.2)	1
NBCA	2 (2.3)	1 (1.6)	1 (4.2)	0.473
Number of post-Whipple open abdominal surgeries				0.068
None	51 (58)	41 (64.1)	10 (41.7)
One time	32 (36.4)	21 (32.8)	11 (45.8)
Two times	5 (5.7)	2 (3.1)	3 (12.5)
Tech success	81 (92)	60 (93.8)	21 (87.5)	0.385
Clinical success	53 (60.2)	46 (71.9)	7 (29.2)	< 0.001
Re-bleeding	20 (22.7)	14 (21.9)	6 (25)	0.779

SMA: Superior mesenteric artery; CT: Computed tomography; NBCA: N-butyl cyanoacrylate; PPH: Post-pancreatectomy hemorrhage.

Table 4 Univariate and multivariate logistic regression analysis of mortality risk factors in patients with delayed post-pancreatectomy hemorrhage

Characteristics	Univariate analysis		Multivariate analysis
	P value	OR (95%CI)	P value	OR 95%CI
Gender	0.1787	1.143 (0.942-1.388)
Age	0.0327	0.990 (0.980-0.999)	0.0018	1.014 (1.005-1.022)
Hypertension	0.0758	1.185 (0.985-1.425)
Diabetes mellitus	0.0300	0.732 (0.555-0.966)
In-hospital days	0.0301	1.003 (1.000-1.006)	< 0.001	0.996 (0.993-0.998)
Pathology diagnosis	0.5150	0.925 (0.732-1.169)
Preoperative total bilirubin	0.6898	1 (0.999-1.001)
Preoperative direct bilirubin	0.4815	1 (0.999-1.002)
Operating duration	0.0760	1 (0.999-1)	0.0044	1.001 (1-1.001)
POPF	0.0350	0.8 (0.667-0.982)
Gastrointestinal fistula	0.7108	1.1 (0.72-1.622)
Bile leakage	0.445	0.9 (0.7-1.169)
Intra-abdominal infection	0.0412	0.8 (0.685-0.99)	0.0053	1.253 (1.074-1.462)
Bleeding latency, days	0.5931	1 (0.997-1.005)
Hemoglobin	0.6565	1 (0.995-1.007)
PLT	0.0799	1 (1-1.002)
APTT	0.0379	1 (0.988-1)	0.0159	0.991 (0.984-0.998)
INR	0.0001	0.7 (0.565-0.819)	0.0113	1.374 (1.081-1.746)
Coagulopathy	0.0051	0.8 (0.629-0.916)	0.0732	1.204 (0.985-1.471)
Severity of PPH-grade B or C	0.0642	0.8 (0.693-1.008)
Asymptomatic hemorrhage	0.0372	1.3 (1.019-1.64)
Pseudoaneurysm detected on postoperative follow-up CT	0.2858	1.3 (0.792-2.22)
Melena or/and hematemesis	1.0000	1 (0.823-1.215)
Sentinel bleeding	0.8936	1 (0.833-1.232)
Hemorrhagic shock	0.0200	0.8 (0.661-0.961)
Strategy of embolization	0.0615	0.8 (0.636-1.008)
Negative on angiography	0.0372	1.3 (1.019-1.64)
Suspicious of contrast agent staining	0.3868	1.3 (0.705-2.479)
Vessel stenosis	0.5229	0.9 (0.734-1.17)
Pseudoaneurysm	0.8538	1 (0.802-1.201)
Contrast medium overflow	0.0051	0.8 (0.629-0.916)
Stump of gastroduodenal artery sign	0.3308	1.2 (0.849-1.629)
Conservative treatment	0.1873	1.2 (0.923-1.516)
Common hepatic artery	0.0454	0.8 (0.687-0.993)	0.0256	1.182 (1.023-1.364)
SMA	0.0933	1.3 (0.955-1.894)
Proper hepatic artery	0.9368	1 (0.696-1.396)
Right hepatic artery	0.8131	0.9 (0.559-1.577)
Left hepatic artery	0.8131	0.9 (0.559-1.577)
Left gastric artery	0.4271	1.2 (0.814-1.629)
Coils	0.0628	0.8 (0.678-1.008)
Stent	0.3308	1.2 (0.849-1.629)
Gelatin sponges	0.9180	1 (0.652-1.609)
NBCA	0.4711	0.8 (0.422-1.488)
Number of post-Whipple interventional embolization	0.6321	1.1 (0.819-1.391)
Number of post-Whipple open abdominal surgeries	0.1404	0.9 (0.71-1.048)
Tech success	0.3402	1.2 (0.838-1.674)
Clinical success	0.0002	1.4 (1.193-1.7)	0.0167	0.813 (0.688-0.96)
Re-bleeding	0.7587	1 (0.771-1.208)

POPF: Postoperative pancreatic fistula; PLT: Platelet count; APTT: Activated partial thromboplastin time; INR: International normalized ratio; PPH: Post-pancreatectomy hemorrhage; CT: Computed tomography; SMA: Superior mesenteric artery; NBCA: N-butyl cyanoacrylate; OR: Odds ratio; CI: Confidence interval.