A creatinine-based model to predict recurrent bleeding after modified percutaneous transhepatic variceal embolization in cirrhotic patients

Abstract

Background: Patients who survived the initial esophagogastric variceal bleeding (EVB) experienced an increased risk of recurrent bleeding and death, but a reliable predictive model is lacking. We aim to develop and validate a model for rebleeding prediction in cirrhotic patients with EVB after modified percutaneous transhepatic variceal embolization (PTVE) with cyanoacrylate.Methods: A total of 122 patients with EVB who underwent PTVE from January 2015 to March 2020 were enrolled in this study. The multivariate logistic analyses were conducted to determine independent risk factors for nomogram construction. The discrimination, calibration and clinical utility of the nomogram were compared with the Model for End-stage Liver Disease (MELD) and Child–Pugh model. Additionally, a risk stratification was developed according to nomogram.Results: Rebleeding within 3 months after PTVE occurred in 32 patients (26.2%). The independent rebleeding indicators included the history of endoscopic therapy, Child–Pugh score, partial splenic embolization and creatinine level. The nomogram incorporating these four predictors achieved excellent calibration and discriminatory abilities with a concordance index of 0.85 which was confirmed to be 0.83 through bootstrapping validation. The nomogram harbored better discrimination and clinical applicability than the MELD and Child–Pugh model. As shown in the Kaplan-Meier curves, the patients at high risk were significantly associated with the high probability of rebleeding (P < 0.001). Conclusions: We created a creatinine-based nomogram to predict rebleeding in cirrhotic patients received PTVE, which could help clinicians to discern the high-risk patients to perform more aggressive treatments earlier and formulate intensive follow-up plan for them.