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CN 22-1108/R
Volume 40 Issue 7
Jul.  2024
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Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(7): 1438-1445

Influencing factors for chronic pancreatitis complicated by pancreatogenic portal hypertension and establishment of a predictive model

DOI: 10.12449/JCH240723
  • 1.

    Department of Gastroenterology，The First Affiliated Hospital of Kunming Medical University，Yunnan Province Clinical Research Center for Digestive Diseases，Kunming 650032，China

  • 2.

    Department of Gastroenterology，Chuxiong Yi Autonomous Prefecture People’s Hospital，Chuxiong，Yunnan 675000，China

  • 3.

    Department of Gastroenterology，Wenshan People’s Hospital，Wenshan，Yunnan 663000，China

  • 4.

    Department of Gastroenterology，Puer People’s Hospital，Puer，Yunnan 665000，China

Research funding:

Yunnan Province Science and Technology Plan Project (202102AA100062)

More Information
  • Corresponding author: ZHANG Hairong， zhr919@sina.com （ORCID： 0000-0002-9918-3673）
  • Received Date: 2023-11-01
  • Accepted Date: 2023-12-21
  • Published Date: 2024-07-25
    Abstract
  •   Objective  To investigate the influencing factors for chronic pancreatitis （CP） complicated by pancreatogenic portal hypertension （PPH）， and to establish a predictive model.  Methods  A retrospective analysis was performed for the clinical data of 99 patients with CP complicated by PPH who were hospitalized in The First Affiliated Hospital of Kunming Medical University， Chuxiong Yi Autonomous Prefecture People’s Hospital， Wenshan People’s Hospital， and Puer People’s Hospital from January 2017 to December 2022， and these patients were enrolled as PPH group. The incidence density sampling method was used to select 198 CP patients from databases as control group. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. The Least Absolute Shrinkage and Selection Operator （LASSO） regression model was used to identify the potential predictive factors for CP complicated by PPH， and the predictive factors obtained were included in the multivariate Logistic regression analysis to obtain independent risk factors， which were used to establish a nomogram prediction model. The receiver operating characteristic （ROC） curve， the calibration curve， and the Hosmer-Lemeshow goodness-of-fit test were used to perform internal validation of the model， and the clinical decision curve was used to assess the clinical practicability of the model.  Results  There were significant differences between the two groups in sex， history of recurrent acute pancreatitis attacks， acute exacerbation of CP， bile duct stones， peripancreatic fluid accumulation， pseudocysts， pulmonary infection， elevated C-reactive protein （CRP）， elevated procalcitonin， fibrinogen （FIB）， neutrophil-lymphocyte ratio （NLR）， gamma-glutamyl transpeptidase， total bilirubin， direct bilirubin， low-density lipoprotein （LDL）， serum amylase， D-dimer， and serum albumin （all P<0.05）. The predictive variables obtained by the LASSO regression analysis included sex， recurrent acute pancreatitis attacks， bile duct stones， peripancreatic fluid accumulation， pulmonary infection， pseudocysts， CRP， NLR， FIB， and LDL. The multivariate Logistic regression analysis showed that sex （odds ratio ［OR］=2.716， P<0.05）， recurrent acute pancreatitis attacks （OR=2.138， P<0.05）， peripancreatic fluid accumulation （OR=2.297， P<0.05）， pseudocysts （OR=2.805， P<0.05）， and FIB （OR=1.313， P<0.05） were independent risk factors for CP complicated by PPH. The above factors were fitted into the model， and the Bootstrap internal validation showed that the nomogram model had an area under the ROC curve of 0.787 （95% confidence interval： 0.730 — 0.844）， and the calibration curve was close to the reference curve. The Hosmer-Lemeshow goodness-of-fit test showed that the model had a good degree of fitting （χ2=7.469， P=0.487）. The clinical decision curve analysis showed that the prediction model had good clinical practicability.  Conclusion  Male sex， recurrent acute pancreatitis attacks， peripancreatic fluid accumulation， pseudocysts， and FIB are independent risk factors for CP complicated by PPH， and the nomogram model established has good discriminatory ability， calibration， and clinical practicability.

     

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