Nomogram-based prediction of portal vein system thrombosis formation after splenectomy in patients with hepatolenticular degeneration

Abstract

ObjectiveSplenectomy is a vital treatment method for hypersplenism with portal hypertension. However, portal venous system thrombosis (PVST) is a serious problem after splenectomy. Therefore, constructing an effective visual risk prediction model is important for preventing, diagnosing, and treating early PVST in hepatolenticular degeneration (HLD) surgical patients.MethodsBetween January 2016 and December 2021, 309 HLD patients were selected. The data were split into a development set (215 cases from January 2016 to December 2019) and a validation set (94 cases from January 2019 to December 2021). Patients’ clinical characteristics and laboratory examinations were obtained from electronic medical record system, and PVST was diagnosed using Doppler ultrasound. Univariate and multivariate logistic regression analyses were used to establish the prediction model by variables filtered by LASSO regression, and a nomogram was drawn. The area under the curve (AUC) of receiver operating characteristic (ROC) curve and Hosmer–Lemeshow goodness-of-fit test were used to evaluate the differentiation and calibration of the model. Clinical net benefit was evaluated by using decision curve analysis (DCA). The 36-month survival of PVST was studied as well.ResultsSeven predictive variables were screened out using LASSO regression analysis, including grade, POD14D-dimer (Postoperative day 14 D-dimer), POD7PLT (Postoperative day 7 platelet), PVD (portal vein diameter), PVV (portal vein velocity), PVF (portal vein flow), and SVD (splenic vein diameter). Multivariate logistic regression analysis revealed that all seven predictive variables had predictive values (P < 0.05). According to the prediction variables, the diagnosis model and predictive nomogram of PVST cases were constructed. The AUC under the ROC curve obtained from the prediction model was 0.812 (95% CI: 0.756–0.869) in the development set and 0.839 (95% CI: 0.756–0.921) in the validation set. Hosmer–Lemeshow goodness-of-fit test fitted well (P = 0.858 for development set; P = 0.137 for validation set). The nomogram model was found to be clinically useful by DCA. The 36-month survival rate of three sites of PVST was significantly different from that of one (P = 0.047) and two sites (P = 0.023).ConclusionThe proposed nomogram-based prediction model can predict postoperative PVST. Meanwhile, an earlier intervention should be performed on three sites of PVST.

Assessment of portal system hemodynamics for the prediction of portal vein thrombosis in cirrhosis—A systematic review and meta‐analysis

“…[31][32][33][34][35][36][37][38][39][40][41][42] Based on the study design, 3 were case-control, 31,35,39 while 9 were cohort studies. [32][33][34][36][37][38][40][41][42] The median follow-up duration varied from 1 to 42.7 months. Tables S1 and S2 summarize the study quality analysis for cohort and case-control studies.…”

“…Eleven studies [15][16][17][18][19][20]22,24,26,28,30 and 9 studies 31,[33][34][35][36]38,[40][41][42] compared the PVD in patients with or without PVT in those with cirrhosis and those with cirrhosis undergoing splenectomy ± devascularization, respectively (Figure 2). In patients with cirrhosis, PVD was significantly higher in those developing PVT compared to those without PVT with an MD of À1.62 cm (95% CI: À2.51 to À0.73;…”

“…Among these 31 studies, 19 included patients with cirrhosis, [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] and 12 included patients with cirrhosis who had undergone splenectomy. [31][32][33][34][35][36][37][38][39][40][41][42] Table 1 shows the baseline characteristics of the included studies. For studies in patients with cirrhosis, 10 studies were from Asia, 14,15,18,21,22,24,[27][28][29][30] and 9 were from non-Asian countries.…”

“…Tables S1 and S2 summarize the study quality analysis for cohort and case-control studies. Among cohort studies, 3 were of poor quality, 13,37,42 3 were of fair quality, 15,34,36 and the rest were of good quality. Among case-control studies, 2 were of poor quality, 22,31 2 were of fair quality, 28,35 and the rest were of good quality.…”

“…On leave-one-out analysis, with the exclusion of the study by Li et al 40 there was no difference in the PVV between the groups with an MD of 0.63 cm/s (95% CI: À0.01 to 1.28). On pooling the data from multivariable analyses of the included studies, 16,17,24,26,40,42 PVV was a significant predictor of PVT in patients with cirrhosis without or with splenectomy with OR 0.93 (95% CI: 0.91-0.96; I 2 = 95%) and OR 0.71 (95% CI: 0.61-0.83;…”