关键词: 肝硬化, 食管胃底静脉曲张破裂出血, 肝体积, 脾体积, 纤维蛋白原, 预后模型

Abstract:

Objective To evaluate the utility of the liver-spleen volume ratio and fibrinogen in predicting the risk of esophagogastric variceal bleeding in patients with cirrhosis. Methods A total of 130 cirrhotic patients with esophagogastric variceal bleeding were recruited from among those admitted to Nantong Third People's Hospital between January 2020 and December 2022. Clinical data， blood test results， biochemical assay findings， coagulation test outcomes， and computed tomography （CT） scan results were collected. Based on their 1-year prognosis， the patients were classified into a non-bleeding group （n = 71） and a re-bleeding group （n = 59）. For normally distributed continuous variables， an independent samples t-test was employed； for non-normally distributed continuous variables， the Mann-Whitney U test was used； and for categorical variables， the chi-square test or Fisher's exact probability test was applied. Multivariable analysis was conducted to identify independent risk factors for esophageal and gastric variceal bleeding （EGVB） in cirrhotic patients. A predictive model integrating the liver-to-spleen volume ratio （LSVR） and fibrinogen （FIB） was then established. The clinical effectiveness of LSVR， FIB alone， and their combination was evaluated using receiver operating characteristic （ROC） curve analysis. The optimal cut-off value of the combined LSVR and FIB for predicting the prognosis of EGVB was calculated， and survival curves were plotted using the Kaplan-Meier method. Results Clinically relevant differences were observed in AST， FIB， D-dimer， MELD， ALBI scores， spleen volume， and the liver-to-spleen volume ratio between the two groups （P < 0.05）. Multivariable analysis indicated that LSVR （OR = 3.347， 95%CI： 1.624 ~ 6.899， P = 0.001） and FIB （OR =0.206， 95% CI： 0.078 ~ 0.544， P = 0.001） were independent risk factors for the prognosis of EGVB. The area under the receiver operating characteristic curve （AUC） was the largest when LSVR was combined with FIB （AUC = 0.825， 95% CI： 0.751 ~ 0.899）， which was higher than that of LSVR alone （AUC = 0.731， 95%CI： 0.639 ~0.822） and FIB alone （AUC = 0.683， 95%CI： 0.589 ~ 0.777）. The optimal cutoff value of the combination of LSVR and FIB was -2.741， with a specificity of 81.7% and a sensitivity of 74.6%. Kaplan-Meier survival analysis demonstrated that patients with LSVR combined with FIB < -2.741 had a 1-year non-bleeding rate of 53.4% （39/73）， which was significantly higher than the 7.0% （4/57） in patients with LSVR combined with FIB ≥ -2.741， and the difference was statistically significant （P < 0.001）. Conclusions Compared with using LSVR or FIB alone， combining LSVR with FIB enhances the predictive efficacy for 1-year re-bleeding in EGVB patients. This model could serve as an objective and straightforward tool for better clinical implementation.

Key words: liver cirrhosis, esophagogastric variceal bleeding, liver volume, spleen volume, fibrinogen, prognostic model