Abstract
PurposeBiliary leakage caused by cystobiliary communication (CBC) is a common clinical concern. This study sought to identify predictors of CBC in hepatic cystic echinococcosis (HCE) patients undergoing hydatid liver cyst surgery and establish nomograms to predict CBC.MethodsA predictive model was established in a training cohort of 310 HCE patients diagnosed between January 2013 and May 2017. Upon revision of the records of clinical parameters and imaging features of these patients, the lasso regression model was used to optimize feature selection for the CBC risk model. Combined with feature selection, a CBC nomogram was developed with multivariable logistic regression. C-index and calibration plots were used to analyze and evaluate the discrimination and calibration. The net benefit and predictive accuracy of the nomogram were performed via decision curve analysis (DCA) and receiver operating characteristic (ROC) curve. An independent validation cohort of 132 patients recruited from June 2017 to May 2019 was used to evaluate the practicability of the nomogram.ResultsPredictors contained four features, namely alkaline phosphatase (ALP), glutamyl transpeptidase (GGT), cyst size and cyst location. The C-index of the nomogram is 0.791 (95% CI, 0.736–0.845), while the C-index verified by bootstrap is 0.746, indicating high prediction accuracy. The area under the curve (AUC) of the CBC in training was 0.766. ROC curve analysis demonstrated high sensitivity and specificity. Decision curve analysis confirmed the CBC nomogram was clinically useful when the intervention was determined at the non-adherence possibility threshold of 8%.ConclusionThe nomogram developed using the ALP, GGT, cyst size and cyst location could be used to facilitate the CBC risk prediction in HCE patients.
Highlights
Hepatic cystic echinococcosis (HCE), caused by Echinococcus granulosus, is a zoonotic parasitic disease
Decision curve analysis confirmed the cystobiliary communication (CBC) nomogram was clinically useful when the intervention was determined at the non-adherence possibility threshold of 8%
This study mainly explores the independent risk factors affecting the occurrence of CBC in hepatic cystic echinococcosis and establishes a nomogram model for individualized CBC risk prediction in CE patients, so as to help clinicians in high-risk areas of echinococcosis find high-risk patients of CBC early and reduce the occurrence of postoperative complications
Summary
Hepatic cystic echinococcosis (HCE), caused by Echinococcus granulosus, is a zoonotic parasitic disease. The epidemic area of HCE covers the entire planet with the exception of Antarctica [1]. The occurrence of cystic echinococcosis (CE) can be caused by human consumption of food contaminated by insect eggs. World J Surg (2020) 44:3884–3892 is commonly used for CE, but regardless of the type of operation used, bile leakage is the most common complication after CE surgery [3]. It is one of the main causes of increased mortality and prolonged hospital stay in patients with cystic echinococcosis
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