Prognostic model for esophagogastric variceal rebleeding after endoscopic treatment in liver cirrhosis: A Chinese multicenter study  

作　　者：Jun-Yi Zhan Jie Chen Jin-Zhong Yu Fei-Peng Xu Fei-Fei Xing De-Xin Wang Ming-Yan Yang Feng Xing Jian Wang Yong-Ping Mu 

机构地区：[1]Cell Biology Laboratory,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China [2]Institute of Liver Diseases,Shanghai Academy of Chinese Medicine,Shanghai 201203,China [3]Clinical Key Laboratory of Traditional Chinese Medicine of Shanghai,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China [4]Key Laboratory of Liver and Kidney Disease of the Ministry of Education,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China [5]Department of Gastroenterology and Hepatology,Zhongshan Hospital Affiliated to Fudan University,Shanghai 200032,China [6]Shanghai Institute of Liver Disease,Fudan University,Shanghai 200032,China [7]Evidence-Based Medicine Center,Fudan University,Shanghai 200032,China [8]Department of Gastrointestinal Endoscopy,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China [9]Department of Hepatology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China

出　　处：《World Journal of Gastroenterology》2025年第2期85-101,共17页世界胃肠病学杂志（英文）

基　　金：Supported by National Natural Science Foundation of China,No.81874390 and No.81573948;Shanghai Natural Science Foundation,No.21ZR1464100;Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission,No.22S11901700;the Shanghai Key Specialty of Traditional Chinese Clinical Medicine,No.shslczdzk01201.

摘　　要：BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.

关 键 词：Esophagogastric variceal bleeding Variceal rebleeding Liver cirrhosis Prognostic model Risk stratification Secondary prophylaxis 

分 类 号：R575.2[医药卫生—消化系统]