Nomogram Analysis and Internal Validation to Predict the Risk of Cystobiliary Communication in Patients Undergoing Hydat
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ORIGINAL SCIENTIFIC REPORT
Nomogram Analysis and Internal Validation to Predict the Risk of Cystobiliary Communication in Patients Undergoing Hydatid Liver Cyst Surgery Zhan Wang1 • Jin Xu2 • MingQuan Pang1 • Bin Guo3 • XiaoLei Xu1 • HaiJiu Wang1 Ying Zhou1 • Li Ren1 • LingQiang Zhang1 • Jie Ma1 • HaiNing Fan1,4
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Ó The Author(s) 2020
Abstract Purpose Biliary 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. Methods A 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. Results Predictors 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%. Conclusion The nomogram developed using the ALP, GGT, cyst size and cyst location could be used to facilitate the CBC risk prediction in HCE patients.
Introduction & HaiNing Fan [email protected] 1
Department of Hepatopancreatobiliary Surgery, The Affiliated Hospital of Qinghai University, Xining, China
2
Qinghai University, Xining, China
3
Department of Otorhinolaryngology, The Affiliated Hospital of Qinghai University, Xining, China
4
Qinghai Province Key Laboratory of Hydatid Disease Research, 29 Tongren Road, Xining 810001, Qinghai, China
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. Most infections affect the liver (about 75–80%), a few affect the lung (about 8–15%) and the rest are distributed in the kidney, spleen, omentum, pelvic cavity, brain, etc. [2]. Surgic
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