A Nomogram for Predicting Portal Hypertensive Gastropathy in Patients With Liver Cirrhosis: A Retrospective Analysis

Wensheng Wang,Xinru Yin,Zhiyong Mu,Dongfeng Chen,Guangxi Zhu,Yan Guo,Liangzhi Wen,Tao Wang,Shujie Lai

doi:10.3389/fmed.2022.834159

Abstract

BackgroundThere is an urgent need for non-invasive methods for predicting portal hypertensive gastropathy (PHG). This study aims to develop and validate a non-invasive method based on clinical parameters for predicting PHG in patients with liver cirrhosis (LC).MethodsThe overall survival (OS) and hepatocellular carcinoma (HCC)-free survival were evaluated in LC patients, both with and without PHG. A prediction model for PHG was then constructed based on a training dataset that contained data on 492 LC patients. The discrimination, calibration, and clinical utility of the predicting nomogram were assessed using the C-index, calibration plot, and decision curve analysis. Internal validation was conducted using a bootstrapping method, and further external validation using data on the 208 other patients.ResultsLC patients with PHG had a worse prognosis compared with those without PHG. A nomogram was constructed using clinical parameters, such as age, hemoglobin content, platelet count and Child-Pugh class. The C-index was 0.773 (95% CI: 0.730–0.816) in the training cohort, 0.761 after bootstrapping and 0.745 (95% CI: 0.673–0.817) in the validation cohort. The AUC values were 0.767, 0.724, and 0.756 in the training, validation and total cohorts, respectively. Well-fitted calibration curves were observed in the training and validation cohorts. Decision curve analysis demonstrated that the nomogram was clinically useful at a threshold of 15%.ConclusionThe nomogram constructed to predict the risk of developing PHG was found to be clinically viable. Furthermore, PHG is an independent risk factor for OS of LC, but not for the occurrence of HCC.

Highlights

Portal hypertensive gastropathy (PHG) is a critical but ignored complication of liver cirrhosis (LC), and is frequently diagnosed using endoscopy through the observation of its characteristic mosaic-like pattern with or without red spots
PHG was more prevalent in patients with more fibrosis on liver biopsy (26% in patients with Ishak score of 3 and 51% in patients with Ishak score of 6), which suggested that PHG could be associated with more severe portal hypertension [5, 6]
38.4% of patients had a history of chronic liver disease spanning more than 5 years, fewer than 100 patients had undergone endoscopic therapies, such as ligation or sclerosis for varices

Summary

Introduction

Portal hypertensive gastropathy (PHG) is a critical but ignored complication of liver cirrhosis (LC), and is frequently diagnosed using endoscopy through the observation of its characteristic mosaic-like pattern with or without red spots. A Nomogram for PHG thrombi [1] It can be caused by cirrhotic or non-cirrhotic portal hypertension that result in hyperdynamic circulation and gastric congestion, its exact pathogenesis is unclear [2]. Esophageal varix (EV) is the most common cause of upper gastrointestinal bleeding in cirrhotic patients with portal hypertension. Addition to EV, PHG is one of the most common causes of cirrhotic related upper gastrointestinal bleeding which should be took into account. The incidence of PHG-related acute and chronic gastrointestinal bleeding is about 2–12% and 3–60%, respectively [1]. There is an urgent need for non-invasive methods for predicting portal hypertensive gastropathy (PHG). This study aims to develop and validate a non-invasive method based on clinical parameters for predicting PHG in patients with liver cirrhosis (LC)

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