老年肝硬化患者发生门脉高压性上消化道出血的危险因素分析及无创预测模型的建立

Analysis of risk factors for upper gastrointestinal hemorrhage caused by portal hypertension in elderly patients with cirrhosis and establishment of non-invasive prediction model

目的 分析老年肝硬化患者发生门脉高压性上消化道出血的危险因素,联合超声参数及血清学指标构建风险预测模型并评估模型的预测效能。方法 回顾性分析2022年1月-2023年7月在新疆医科大学第一附属医院收治的老年肝硬化患者的临床资料,根据是否出现门脉高压性上消化道出血分为出血组109例和对照组153例,其中2022年1月-2023年4月间的病例纳入造模队列,2023年5月-2023年7月期间的病例纳入验证队列。分析比较两组的临床资料,采用单因素及多因素回归分析影响出血发生的危险因素,建立无创预测模型。采用受试者工作特征曲线下面积(AUC)评估该模型的预测效能。结果 老年肝硬化患者门脉高压性上消化道出血的发生与门静脉主干内径、脾脏长径、白蛋白(ALB)、血小板计数(PLT)、红细胞体积分布宽度(RDW)有关(P均<0.05)。多因素回归分析显示,门静脉主干内径(OR=11.785,95%CI:1.847~75.216)、PLT(OR=0.992,95%CI:0.984~0.999)、RDW(OR=1.407,95%CI:1.218~1.625)均为影响老年肝硬化患者发生门脉高压性上消化道出血的独立危险因素(P均<0.05)。将上述3个指标以及回归系数代入Logistic回归方程公式,得到最终的拟合方程式为:Logit(P)=2.467×门静脉主干内径-0.008×PLT+0.341×RDW-7.069,构建的预测模型在造模队列和验证队列的AUC值分别为0.82和0.819。表明对老年肝硬化患者发生门脉高压性上消化道出血有一定预测价值。结论 门静脉主干内径、PLT、RDW是老年肝硬化患者发生门脉高压性上消化道出血的独立危险因素,联合上述风险因子建立无创预测模型,对预测门脉高压性上消化道出血发生有一定效能。

Objective To analyze the risk factors of upper gastrointestinal hemorrhage by portal hypertension in elderly patients with cirrhosis,and the risk prediction model was constructed in combination with ultrasound parameters and serological in dexes,and the predictive efficacy of the model was evaluated.MethodsRetrospective analysis of clinical data of elderly patients with cirrhosis admitted to the hospital from January 2022 to July 2023.Based on the presence of portal hypertension induced upper gastrointestinal hemorrhage,109 cases were divided into hemorrhage group and 153 cases into control group.Cases from January 2022 to April 2023 were included in the modeling cohort,while those from May 2023 to July 2023 were included in the validation cohort.Clinical data of 2 groups were analyzed and compared.Univariate and multivariate regression analysis were adopted to to identify risk factors affecting hemorrhage occurrence so that a non-invasive predictive model was constructed.The predictive performance of the model was evaluated using the area under the receiver operating characteristic curve(AUC).ResultsThe occurrence of upper gastrointestinal hemorrhage caused by portal hypertensive in elderly patients with cirrhosis were related to the diameter of the main portal vein,the length of the spleen,albumin(ALB),platelet count(PLT)and red blood cell volume distribution width(RDW)(P all<0.05).Multivariate regression analysis showed that the main diameter of the portal vein(OR=11.785,95%CI:1.847-75.216),PLT(OR=0.992,95%CI:0.984-0.999)and RDW(OR=1.407,95%CI:1.218-1.625)were all independent risk factors for portal hypertensive upper gastrointestinal hemorrhage in elderly patients with cirrhosis(P all<0.05).Substituting the above 3 indicators and regression coefficients into the Logistic regression equation formula,the final fitting equation was:Logit(P)=2.467×Portal vein main diameter-0.008×PLT+0.341×RDW-7.069,the AUC values of the constructed prediction model in the modeling queue and validation queue were 0.82 and 0.819,respectively.It indicated that the model had certain predictive value for the occurrence of upper gastrointestinal hemorrhage cuased by portal hypertension in elderly patients with cirrhosis.ConclusionThe main diameters of the portal vein,PLT and RDW are the independent risk factors for portal hypertensive upper gastrointestinal hemorrhage in elderly patients with cirrhosis.Combining these risk factors to establish a non-invasive predictive model has certain efficacy in predicting the occurrence of portal hypertensive upper gastrointestinal hemorrhage.