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Volume 38 Issue 5
May  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(5): 1081-1085

Characteristic manifestations of ΔCT in hepatitis B cirrhosis with upper gastrointestinal bleeding and establishment of a predictive model

DOI: 10.3969/j.issn.1001-5256.2022.05.020

  • Tianjin First Central Hospital; Department of Liver Transplantation, The First Central Clinical College of Tianjin Medical University, Tianjin 300192, China

Research funding:

National Natural Science Foundation of China (81870444)

More Information
  • Corresponding author: ZHENG Hong, zhenghongxy@163.com(ORCID: 0000-0001-8318-3372)
  • Received Date: 2022-02-21
  • Accepted Date: 2022-03-26
  • Published Date: 2022-05-20
    Abstract
  •   Objective  To investigate the CT characteristics of hepatitis B cirrhosis, and to predict the risk of bleeding by establishing a predictive model for upper gastrointestinal bleeding in liver cirrhosis.  Methods  A retrospective analysis was performed for the clinical data of 101 patients with hepatitis B cirrhosis who were admitted to Tianjin First Central Hospital from January 2015 to June 2021, and these patients were divided into upper gastrointestinal bleeding group and non- bleeding group. The two groups were compared in terms of laboratory findings and CT values in plain scan, arterial phase, portal vein phase, and venous phase measured by contrast-enhanced CT, and the changes in CT values (ΔCT) across different phases were calculated. The t-test or the Mann-Whitney U rank sum test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. Logistic regression analysis was used to predict the related risk factors; The discrimination of the model was evaluated by calculating the area under the working characteristic curve of the subjects, and the model calibration criteria were determined by Hosmer-lemeshow. Based on the results of multivariate logistic regression analysis, Rstudio4.1.2 R package was used to establish a predictive model, and draws the corresponding ROC curve, calibration curve and clinical decision curve.  Results  There were significant differences in serum TBil, WBC and PLT levels between the non-bleeding group and the bleeding group (all P < 0.05). There were significant differences in liver-plain, spleen-P-plain and spleen-P-A ΔCT(all P < 0.05). The univariate logistic analysis showed that there were significant differences in leukocytes (odds ratio [OR]=0.770, 95% confidence interval [CI]: 0.624-0.952, P=0.016), platelets (OR=0.979, 95%CI: 0.965-0.994, P=0.006), liver plain scan (OR=1.142, 95%CI: 1.058-1.233, P=0.001), ΔCT value of the spleen from portal vein phase to plain scan (OR=0.979, 95%CI: 0.959-1.000, P=0.050), and ΔCT value of the spleen from portal vein phase to arterial phase (OR=0.979, 95% CI: 0.944-0.994, P=0.015) between the hepatitis B cirrhosis patients with upper gastrointestinal bleeding and those without bleeding. The multivariate logistic analysis showed that platelets (OR=0.968, 95%CI: 0.944-0.993, P=0.011), liver plain phase (OR=1.148, 95%CI: 1.047-1.259, P=0.003), and ΔCT value of the spleen from portal vein phase to arterial phase (OR=0.951, 95%CI: 0.908-0.995, P=0.030) were independent risk factors for upper gastrointestinal bleeding. A predictive model for upper gastrointestinal bleeding in hepatitis B cirrhosis was established based on the results of the multivariate logistic analysis, and a calibration curve was plotted. This model had an area under the receiver operating characteristic curve of 0.801 at the cut-off value of 0.433, with a sensitivity of 81.4% and a specificity of 77.6%. The calibration curve of the model fitted well with the ideal curve.  Conclusion  There are special ΔCT changes in hepatitis B cirrhosis, and the predictive model based on ΔCT has a good predictive ability for upper gastrointestinal bleeding in patients with hepatitis B cirrhosis.

     

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    • References(9)
  • [1]
    ROSE CF, AMODIO P, BAJAJ JS, et al. Hepatic encephalopathy: Novel insights into classification, pathophysiology and therapy[J]. J Hepatol, 2020, 73(6): 1526-1547. DOI: 10.1016/j.jhep.2020.07.013.
    [2]
    DING HG, ZHANG SB, LI L, et al. Endoscopic diagnosis and treatment of esophageal and gastric varices in patients with liver cirrhosis: From guidelines to clinical practice[J]. J Clin Hepatol, 2017, 33(3): 454-457. DOI: 10.3969/j.issn.1001-5256.2017.03.011.

    丁惠国, 张世斌, 李磊, 等. 肝硬化食管胃底静脉曲张的内镜诊断治疗——从指南到临床实践[J]. 临床肝胆病杂志, 2017, 33(3): 454-457. DOI: 10.3969/j.issn.1001-5256.2017.03.011.
    [3]
    TIAN XG, ZHANG CQ. Therapeutic strategy for gastroesophageal variceal bleeding of portal hypertension[J]. J Clin Hepatol, 2015, 31(3): 354-356. DOI: 10.3969/j.issn.1001-5256.2015.03.009

    田相国, 张春清. 门静脉高压并食管胃底静脉曲张出血的治疗策略[J]. 临床肝胆病杂志, 2015, 31(3): 354-356. DOI: 10.3969/j.issn.1001-5256.2015.03.009.
    [4]
    NAGAYAMA Y, KATO Y, INOUE T, et al. Liver fibrosis assessment with multiphasic dual-energy CT: Diagnostic performance of iodine uptake parameters[J]. Eur Radiol, 2021, 31(8): 5779-5790. DOI: 10.1007/s00330-021-07706-2.
    [5]
    Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B: a 2015 update[J]. J Clin Hepatol, 2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002

    中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2015年更新版)[J]. 临床肝胆病杂志, 2015, 31(12): 1941-1960. DOI: 10.3969/j.issn.1001-5256.2015.12.002.
    [6]
    ZHANG X, LI XC, LIN DZ. Clinical efficacy of octreotide combined with entecavir in the treatment of elderly liver cirrhosis complicated with upper gastrointestinal bleeding and its effect on blood transfusion volume and hemostasis time[J]. Chin J Gerontol, 2021, 41(12): 2526-2528. DOI: 10.3969/j.issn.1005-9202.2021.12.020.

    张旭, 黎学聪, 林道壮. 奥曲肽联合恩替卡韦治疗老年肝硬化合并上消化道出血的临床疗效及对输血量、止血时间的影响[J]. 中国老年学杂志, 2021, 41(12): 2526-2528. DOI: 10.3969/j.issn.1005-9202.2021.12.020.
    [7]
    YAN SP, WU H, WANG GC, et al. A new model combining the liver/spleen volume ratio and classification of varices predicts HVPG in hepatitis B patients with cirrhosis[J]. Eur J Gastroenterol Hepatol, 2015, 27(3): 335-343. DOI: 10.1097/MEG.0000000000000269.
    [8]
    YANG LB, XU JY, TANTAI XX, et al. Non-invasive prediction model for high-risk esophageal varices in the Chinese population[J]. World J Gastroenterol, 2020, 26(21): 2839-2851. DOI: 10.3748/wjg.v26.i21.2839.
    [9]
    GAO YJ, GAO ZL, SUN WJ, et al. Quantitative assessment of hepatic and splenic blood flow status in patients with hypersplenism of different degrees based on multi-slice spiral CT whole-liver perfusion imaging[J]. Chin J Heptol, 2020, 28(4): 326-331. DOI: 10.3760/cma.j.cn501113-20190518-00174.

    高雨佳, 高知玲, 孙文杰, 等. 多层螺旋CT全肝灌注成像对不同程度脾功能亢进患者肝脾血流状态的评估[J]. 中华肝脏病杂志, 2020, 28(4): 326-331. DOI: 10.3760/cma.j.cn501113-20190518-00174.
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