Nomogram for Predicting Portal Vein Thrombosis in Cirrhotic Patients: A Retrospective Cohort Study

Abstract

Aim: Portal vein thrombosis (PVT) is a common complication in cirrhotic patients and will aggravate portal hypertension, thus leading to a series of severe complications. The aim of this study was to develop a nomogram based on a simple and effective model to predict PVT in cirrhotic patients. Methods: Clinical data of 656 cirrhotic patients with or without PVT in the First Affiliated Hospital of Soochow University and The Third Affiliated Hospital of Nantong University from January 2017 to March 2022 were retrospectively collected, and all patients were divided into training, internal and external validation cohorts. SPSS and R software were used to identify the independent risk factors and construct a predictive model. We evaluated the predictive value of the model by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analyses. The feasibility of the model was further validated in the internal and external cohorts. All enrolled patients were followed up to construct the survival curves and calculate the incidence of complications. Results: The predictors of PVT included serum albumin, D-dimer, portal vein diameter, splenectomy, and esophageal and gastric varices. Based on the clinical and imaging findings, the final model served as a potential tool for predicting PVT in cirrhotic patients, with an AUC of 0.806 (0.766 in the internal validation cohort and 0.845 in the external validation cohort). The decision curve analysis revealed that the model had a high level of concordance between different medical centers. There was a significant difference between the PVT and non-PVT groups in survival analyses, with p values of 0.0477 and 0.0319 in the training and internal validation groups, respectively, along with p value of 0.0002 in the external validation group according to log-rank test; meanwhile, the median survival times of the PVT group were 54, 43, and 40 months, respectively. The incidence of recurrent esophageal and gastric variceal bleeding (EGVB) during the follow-up showed significant differences among the three cohorts (p = 0.009, 0.048, and 0.001 in the training, internal validation, and external validation cohorts, respectively). Conclusion: The nomogram based on our model provides a simple and convenient method for predicting PVT in cirrhotic patients. Cirrhotic patients with PVT had a shorter survival time and were prone to recurrent EGVB compared with those in the non-PVT group.

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

“…The search strategy yielded 2709 records, of which 31 studies were included in the final analysis 12–42 . Figure 1 shows the flowchart for the study selection and inclusion process.…”

“…The length of the spleen between patients with or without PVT was compared by five studies in patients with cirrhosis 18,20,22,23,30 and seven studies [33][34][35]37,[39][40][41] in patients with cirrhosis undergoing splenectomy ± devascularization (Figure S1). The splenic length was significantly shorter in patients not developing PVT compared to those developing PVT, both in patients with cirrhosis and those with cirrhosis undergoing splenectomy ± devascularization, with MD of À1.17 cm (95% CI: À1.59 to À0.75; I 2 = 60%) and À0.98 cm (95% CI:…”

“…[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. 12,13,16,17,19,20,23,24,26 Based on the study design, 8 were case-control, 12,18-20,22,24,27,28 while 11 were cohort studies.…”

“…Figure 1 shows the flowchart for the study selection and inclusion process. 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.…”

“…12,13,16,17,19,20,23,24,26 Based on the study design, 8 were case-control, 12,18-20,22,24,27,28 while 11 were cohort studies. [13][14][15][16][17]21,23,25,26,29,30 The median follow-up duration varied from 1 to 11 years. For studies in patients with cirrhosis undergoing splenectomy, all the studies were from China.…”