Establishment Of Clinical Prediction Models For Hepatic Alveolar Echinococcosis Complicated With Extrahepatic Organ Metastasis

Background/Aims: The appearance of extrahepatic organ metastasis of alveolar echinococcosis is one of the most harmful aspects of the disease,and it is also an important cause of death of the patient.If metastases are detected early,combined surgery can be performed after multidisciplinary consultation,but the clinical symptoms of early patients are not obvious,and the epidemic areas are mostly remote areas.The level of medical equipment and diagnosis and treatment is relatively backward,which can easily cause misdiagnosis and missed diagnosis.Most patients have already lost the opportunity for surgery when they go to hospital,and the prognosis is extremely poor.At present,the mechanism of hepatic alveolar echinococcosis complicated with extrahepatic organ metastasis is not yet clear,and related risk factors have not been fully determined.By analyzing the clinical data of related patients,this study aims to explore the risk factors of hepatic alveolar echinococcosis complicated with extrahepatic organ metastasis and establish a clinical prediction model to achieve individualized prediction and risk assessment for related patients.Methods: Retrospective analysis clinical data of patients with hepatic alveolar echinococcosis complicated with and without extrahepatic organ metastasis admitted to the Department of Hepatobiliary and Pancreatic Surgery,Affiliated Hospital of Qinghai University from October 2015 to October2019.According to the time of admission,the patients admitted from October 2015 to April 2018(311 cases)were included in the training cohort,and the patients admitted from May 2018 to October 2019(142 cases)were included in the validation cohort.Using Logistic regression to analyze single factor and multiple factor of training cohort,the independent risk factors screened out are used to construct a clinical prediction model and visualize it.Use the training cohort and validation cohort to verify the clinical prediction model internally and externally,and evaluate the discrimination and calibration of the clinical prediction model with the aid of receiver characteristic operating curve(ROC)and calibration curve.Results:1.Multivariate logistic regression suggested: gender(OR=0.366,95% CI 0.213～0.628,P=0.000),globulin(OR=2.270,95% CI 1.318 ～ 3.909,P=0.003),intrahepatic lesions invading the posterior inferior vena cava(OR=3.515,95% CI 2.042～6.051,P=0.000)intrahepatic lesions invading the hepatic vein(OR=2.344,95% CI1.657～3.316,P=0.000)are independent risk factors for hepatic alveolar echinococcosis complicated with extrahepatic organ metastasis.The model of hepatic alveolar echinococcosis complicated with extrahepatic organ metastasis: logit P=-0.216+1.257×intrahepatic lesions invading the posterior inferior vena cava+0.852×intrahepatic lesions invading the hepatic vein+0.820×globulin-1.406×gender.2.The area under the ROC curve of the clinical prediction model internally verified and externally verified are 0.787 and 0.782,respectively,indicating that the model has excellent distinguishing ability for patients with alveolar echinococcosis without metastasis of extrahepatic organs and metastasis of extrahepatic organs.The calibration curves drawn separately indicate that the predicted probability of the model is consistent with the actual occurrence probability.Conclusions:1.Gender,globulin,intrahepatic lesions invading the posterior inferior vena cava,and intrahepatic lesions invading the hepatic vein are independent risk factors for hepatic alveolar echinococcosis complicated with extrahepatic organ metastasis.2.The clinical prediction model constructed based on gender,globulin,intrahepatic lesions invading the posterior inferior vena cava,and intrahepatic lesions invading hepatic veins has good discrimination and calibration;3.Up to now,the nomogram constructed in this study is the only and effective reference tool for guiding individualized treatment and assessing the risk of hepatic alveolar echinococcosis complicated with extrahepatic organ metastasis,.It is expected to realize early detection,early diagnosis and early treatment of relevant patients,so as to maximize the clinical benefit of patients.