Establishment And Role Exploration Of A Nomogram To Predict Recurrent Hemoptysis Due To Bronchiectasis After Bronchial Artery Embolization

OBJECTIVE: To investigate the risk factors for recurrence of hemoptysis within 2 years after bronchial artery embolization(BAE)in patients with bronchiectasis-related hemoptysis,and to construct a prediction model to provide a basis for identifying patients at high risk of recurrence of hemoptysis in the clinical treatment,to achieve early intervention and reduce the risk of recurrence of hemoptysis in patients.METHODS: Patients admitted between January 2018 and January 2021 and diagnosed with bronchiectasis-related hemoptysis and treated with BAE were included as the study population.Clinical data of patients meeting the inclusion criteria were retrospectively collected and followed up for 2 years to track the recurrent event at 3 months,6 months,1year,and 2 years postoperatively.SPSS 26.0 was used to perform baseline data analysis and univariate analysis,and R language version 4.22 was used for variables screening and multifactor analysis.Prognostic model was constructed based on nomogram,and the model was evaluated for discrimination and net benefit,and the Bootstrap method was used to verify the validity of the model.RESULTS: 224 patients diagnosed with bronchiectasis-related hemoptysis were analyzed retrospectively,6(2.68%)of which had a recurrent event within 3 months after BAE,15(6.70%)of which had a cumulative recurrence within 6 months after BAE,18(8.03%)of which had a cumulative recurrence within 1 year after BAE,and 31(13.84%)of which had a cumulative recurrence within 2 years after BAE.Univariate analysis showed that the presence of non-bronchial systemic arteries(P<0.001),operation duration(P=0.011),the total number of embolized abnormal systemic arteries(P=0.001),and the number of non-bronchial systemic arteries(P<0.001),and the presence of bronchial artery-pulmonary shunt(P<0.001)were associated with postoperative recurrence of BAE.The statistically significant factors in the univariate were included in the Lasso regression analysis to screen the variables,and the results showed that bronchial artery-pulmonary shunt and non-bronchial systemic arteries were the variables associated with postoperative recurrence.Inclusion of the above variables in the multivariate analysis showed that: bronchial artery-pulmonary shunt(OR=11.74,95% CI: 4.699-30.58,P<0.001),and non-bronchial systemic arteries(OR=6.299,95% CI: 2.000-28.12,P=0.005)were the independent risk factors for recurrence within 2 years after BAE for bronchiectasis with hemoptysis.A nomogram prediction model was developed based on the recurrence influencing factors,and the area under the ROC curve was 0.786(95% CI: 0.516-0.959)as shown by the ROC performance evaluation.The validated C-index after repeated sampling 1000 times by the Bootstrap method was 0.787,which proved that the model performed well.CONCLUSION: The 2-year recurrence rate after BAE in patients with bronchiectasis-related hemoptysis was 13.84%.Bronchial artery-pulmonary shunt and non-bronchial systemic arteries were the main influencing factors for the recurrence.The nomogram prediction model developed in this study can be used to identify patients at high risk of recurrence after BAE.