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ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 41 Issue 6
Jun.  2025
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Article Navigation >  Journal of Clinical Hepatology  > 2025  >  41(6): 1120-1127

Establishment and validation of a predictive model for survival after transjugular intrahepatic portosystemic shunt in patients with liver cirrhosis and esophagogastric variceal bleeding

DOI: 10.12449/JCH250618
  • 1.

    Department of Gastroenterology，Zhongda Hospital Affiliated to Southeast University，Nanjing 210009，China

  • 2.

    Department of Gastroenterology，Affiliated Drum Tower Hospital of Nanjing University Medical School，Nanjing 210008，China

Research funding:

National Natural Science Foundation of China (82370628)

More Information
  • Corresponding author: ZHANG Feng， fzdndx@126.com （ORCID： 0000-0002-3653-5977）
  • Received Date: 2024-11-11
  • Accepted Date: 2025-01-13
  • Published Date: 2025-06-25
    Abstract
  •   Objective  To investigate the risk factors for survival after transjugular intrahepatic portosystemic shunt （TIPS） in patients with liver cirrhosis and esophagogastric variceal bleeding （EGVB）， and to establish a predictive model for survival after TIPS.  Methods  Clinical data were collected from 352 patients with liver cirrhosis and EGVB who underwent TIPS in Department of Gastroenterology， Affiliated Drum Tower Hospital of Nanjing University Medical School， from January 2015 to December 2018， and the patients were randomly divided into training group （n=248） and validation group （n=104） at a ratio of 7∶3. The Cox regression analysis was used to identify the independent risk factors for survival after TIPS， and a nomogram predictive model was established. The index of concordance （C-index） and the receiver operating characteristic （ROC） curve were used to assess the discriminatory ability of the model， and the calibration curve was used to assess the predictive value of the model. The independent-samples t test was used for comparison of normally distributed continuous data between two groups， and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier analysis was used to calculate cumulative survival rate.  Results  For the patients in the training group， the 1-，3-， and 5-year cumulative survival rates were 91.1%，79.5%， and 77.0%， respectively. The multivariate Cox regression analysis showed that age （hazard ratio ［HR］=1.047， 95% confidence interval ［CI］：1.032‍ ‍—‍ ‍1.092，P<0.001）， MELD score （HR=1.127，95%CI：1.003‍ ‍—‍ ‍1.268，P=0.045）， and serum sodium （Na） （HR=0.928，95%CI：0.878‍ ‍—‍ ‍0.981，P=0.008） were independent influencing factors for survival， and a predictive model and a nomogram were established based on these factors. The predictive model had a C-index of 0.760 in the training group and 0.757 in the validation group. In the training group， the nomogram had an area under the ROC curve of 0.807，0.788， and 0.787， respectively， in predicting 1-，3-， and 5-year cumulative survival rates. The calibration curve showed relatively high consistency between the results predicted by the nomogram and the actual results.  Conclusion  A nomogram model is established based on age， MELD score， and Na for predicting survival after TIPS in patients with liver cirrhosis and EGVB， and this model has good discriminatory ability and accuracy.

     

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