| Objective Patients with cirrhosis complicated with esophagogastric variceal bleeding(EGVB)have a critical condition and high mortality.Therefore,it is of good importance to accurately and quantitatively assess the risk of death in EGVB patients.The purpose of this study is to explore the evaluation value of the easy-albumin-bilirubin score on the 6-week death of EGVB patients,and further establish a regression model based on EZ-ALBI score to evaluate the death risk of EGVB patients,which is helpful to guide treatment and monitor the changes of the disease.Methods In this study,patients who were first diagnosed with "cirrhosis with EGVB" in Jiaxing First Hospital from January 2019 to October 2022 were included for retrospective analysis.Then the prognosis of the patients was obtained through follow-up,and the patients were divided into the death group and the survival group.Pearson correlation analysis was used to evaluate the correlation between the EZ-ALBI score,Child-Turcotte-Pugh score(CTP),and albumin-bilirubin score(ALBI).The independent risk factors affecting the prognosis of patients were screened by logistic regression analysis and a regression model was constructed.The model was verified by receiver operating characteristic curve(ROC),Bootstrap test,HosmerLemeshow test,calibration curve,and clinical decision curve after drawing the nomogram,and an online web computing tool was made.Finally,the model was divided into three grades by using X-tile software,and then Kaplan-Meier survival analysis was used to compare the survival situation of patients in different grades.Results 1.This study included 218 patients,including 117 males(53.7%)and 101 females(46.3%),with a median age of 71(57,76)years.Up to the time of follow-up,44 patients died,of which 27 patients died within 6 weeks,with a total mortality rate of 20.2%and a 6-week mortality rate of 12.4%.2.The EZ-ALBI score,ALBI score,and CTP score were positively correlated with each other,and Pearson correlation coefficients were all>0.7,P<0.001.3.The factors affecting the 6-week prognosis of patients were screened by univariate and multivariate logistic regression analysis,and three regression models were constructed to avoid multicollinearity.In model 1,CTP score(OR=2.430,95%CI:1.690～3.495,P<0.001)and age(OR=1.231,95%CI:1.120～1.353,P<0.001)were statistically significant.In model 2,ALBI score(OR=9.870,95%CI:1.775～54.889,P=0.009),age(OR=1.280,95%CI:1.138～1.441,P<0.001),aspartate transaminase(OR=1.003,95%CI:1.000～1.006,P=0.027)and prothrombin time(OR=1.249,95%CI:1.057～1.475,P=0.009)were statistically significant.In model 3,EZ-ALBI score(OR=1.317,95%CI:1.116～1.553,P=0.001),age(OR=1.255,95%CI:1.129～1.396,P<0.001)and prothrombin time(OR=1.227,95%CI:1.028～1.466,P=0.024)were statistically significant.4.The EZALBI-Age-PT score was established by combining the EZ-ALBI score with age and prothrombin time(PT).The area under the ROC curve was 0.924(95%CI:0.882～0.966),which was higher than the CTP score,the ALBI score,and the EZ-ALBI score,indicating that the model had good discrimination.Hosmer-lemeshow test(P=0.732),Bootstrap test(concordance index=0.942),and Calibration curve shows that the model has good calibration.The decision curve analysis suggests that the model has good clinical applicability.5.There are statistical differences in the survival of patients with different levels of the EZALBI-Age-PT score,and the Log-Rank P<0.001.Conclusion 1.The EZ-ALBI score,CTP score,ALBI score,age,PT,and AST are independent influencing factors for the 6-week prognosis of EGVB patients,and the predictive power of the EZ-ALBI score is equivalent to the CTP score and ALBI score.2.The EZALBI-Age-PT score is superior to the EZ-ALBI score,CTP score,and ALBI score in predicting the 6-week prognosis of EGVB patients.Its grading can distinguish patients with different death risks,and online calculation tools can increase the clinical practicability of the model. |
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