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Volume 40 Issue 9
Sep.  2024
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Article Navigation >  Journal of Clinical Hepatology  > 2024  >  40(9): 1802-1806

Risk factors for portopulmonary hypertension in liver cirrhosis and construction of a predictive model

DOI: 10.12449/JCH240914

  • Department of Infectious Diseases and Hepatology，The Third Affiliated Hospital of Hebei Medical University，Shijiazhuang 050051，China

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  • Corresponding author: WANG Wei， wangwei_1211@126.com （ORCID： 0000-0002-3737-1492）
  • Received Date: 2023-12-31
  • Accepted Date: 2024-02-01
  • Published Date: 2024-09-25
    Abstract
  •   Objective  To investigate the risk factors for portopulmonary hypertension （POPH） in liver cirrhosis， and to construct a noninvasive predictive model.  Methods  A retrospective analysis was performed for the clinical data of 310 cirrhotic patients with portal hypertension who were hospitalized in The Third Affiliated Hospital of Hebei Medical University from January 2013 to August 2022， and according to whether pulmonary artery systolic pressure was ≥40 mmHg on ultrasound， the patients were divided into POPH group with 31 patients and non-POPH group with 279 patients. 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. A binary Logistic regression analysis was used to determine the independent risk factors for POPH， and a nomogram prediction model was constructed. The Bootstrap resampling method was used for internal validation， and C-index and calibration curve were used to assess the discriminatory ability and consistency of the model. The rms package was used to plot the nomogram.  Results  Compared with the non-POPH group， the POPH group had a significantly younger age， a significantly higher proportion of women or patients with hepatic encephalopathy or Child-Pugh class C disease， and significantly higher levels of direct bilirubin， Model for End-Stage Liver Disease score， albumin-bilirubin （ALBI） score， international normalized ratio， prothrombin time， FIB-4 index， LOK score， and Forns index， as well as significantly lower levels of serum albumin， alanine aminotransferase， gamma-glutamyl transpeptidase， hemoglobin， total cholesterol， and triglycerides （all P<0.05）. The multivariate analysis showed that sex （odds ratio ［OR］=0.172， 95% confidence interval ［CI］： 0.064‍ ‍—‍ ‍0.462， P<0.001）， age （OR=0.944， 95%CI：0.901‍ ‍—‍ ‍0.989， P=0.016）， ALBI score （OR=3.091， 95%CI： 1.100‍ ‍—‍ ‍8.687， P=0.032）， and hepatic encephalopathy （OR=3.466， 95%CI： 1.331‍ ‍—‍ ‍9.031， P=0.011） were independent risk factors for POPH. A predictive model for POPH in liver cirrhosis was established based on the above independent risk factors， with a C-index of 0.796 （95%CI： 0.701‍ ‍—‍ ‍0.890）， suggesting that the model had good discriminatory ability， and the calibration curve showed that the model had good calibration ability， suggesting that the model had certain predictive efficacy.  Conclusion  Young female individuals， elevated ALBI score， and comorbidity with hepatic encephalopathy are independent risk factors for POPH in patients with liver cirrhosis， and the predictive model established based on these factors has a certain clinical application value.

     

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