A prediction model of mortality risk after interventional operation on cirrhotic portal hypertensive patients complicated with esophagogastric varices rupture and hemorrhage

Abstract

Abstract: Objective To explore a model for predicting the risk of death following intervention therapy in cirrhotic portal hypertensive (PHT) patients complicated with esophageal and gastric varices bleeding (EGBV). Methods One hundred and twelve patients with PHT complicated with EGBV admitted to our hospital from January 2020 to December 2021 were selected. All patients were treated with intrahepatic portal vein shunt via jugular vein for intervention therapy. After 1 year's follow-up, the patients were divided into a survival group (N=88 cases) and a death group (N=24 cases). The influencing factors of postoperative death were analyzed by univariate and multivariate COX regression method, and a prediction model for the risk of death was built. Results One year after interventional jugular intrahepatic portal vein shunt operation, 88 cases (78.57%) survived. In the death group, the average of portal vein diameter was (15.37±5.48) mm; the ratio of cases with Child Pugh grade B and C was 91.67% (22/24), with hepatic encephalopathy was 66.67% (16/24). The ratio of hemorrhagic shock was 45.83% (11/24), the level of alpha-fetoprotein was (6.14±1.23)μg/L, and the average of MELD score was (16.74±2.13), which were higher than those of 68.118% (60/88), (4.22±1.35) μg/L, and (13.38±2.49) in the survival group. The levels of Serum creatinine (1.42±0.39) μmol/L and albumin (31.46±4.38)g/L in the death group were lower than those of (1.76±0.58)μmol/L and (35.32±5.27)g/L in the survival group (P<0.05). Multivariate COX regression analysis showed that portal vein diameter≥14.26mm {(Hazard Ratio (HR)=2.237, 95%CI=1.381~3.622), combined with hepatic encephalopathy (HR=1.671, 95%CI=1.671~5.745), hemorrhagic shock (HR=2.784, 95%CI=1.746~4.439) and MELD score≥15 points (HR=2.552, 95%CI=1.906~3.418) were independent risk factors for postoperative death in cirrhotic patients with intervention therapy for PHT complicated with EGBV (HR>1, P<0.05). Receiver operating characteristic (ROC) curve analysis showed that the area under the ROC curve of the predictive model for postoperative death was 0.86 (95%CI=0.734~0.923), and the sensitivity and specificity were 83.25% and 68.76%, respectively. Conclusion Portal vein diameter ≥14.26mm, hepatic encephalopathy, hemorrhagic shock, MELD score ≥15 points were independent risk factors for postoperative death in cirrhotic patients after intervention therapy for PHT complicated with EGBV, and the prediction model for postoperative death built on these risk factors had good predictive value.

Key words: Cirrhotic portal hypertension, Esophageal and gastric varices rupture and hemorrhage, Postoperative death, Prediction model

MA Zhi-gang, LIU Li-li, WANG Xu, FENG Peng-li, YANG Fan, YANG Yong-bin. A prediction model of mortality risk after interventional operation on cirrhotic portal hypertensive patients complicated with esophagogastric varices rupture and hemorrhage[J]. Chinese Hepatolgy, 2025, 30(2): 183-186.

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