Analysis of Risk Factors and a Prediction Model for Rebleeding in Liver Cirrhosis Patients with Esophagogastric Variceal Bleeding

Objective To analyze the risk factors for rebleeding in patients with liver cirrhosis and esophagogastric variceal bleeding (EGVB) in Hainan, China; to identify independent predictors associated with rebleeding; and to construct and validate a non-invasive and simple prediction model for rebleeding. Methods This retrospective study selected 130 patients with cirrhosis and esophagogastric variceal bleeding (EGVB) who were treated at the Second Affiliated Hospital of Hainan Medical University in 2024 and conducted a one-year telephone follow-up observation. With rebleeding within 1 year as the study endpoint, patients were divided into a rebleeding group and a non-rebleeding group. Relevant clinical data were collected, including patient name, gender, age, etiology of cirrhosis (hepatitis B, hepatitis C, alcohol, other causes). Laboratory tests included blood routine, liver function, renal function, coagulation function, imaging, and endoscopic features. Basic data and laboratory/imaging examination data were statistically analyzed. Finally, based on the results of the LASSO regression analysis. a nomogram model was constructed to predict the risk of EGV rebleeding. his graphical calculating tool, based on a multivariate regression model, visually represents the predicted probability of a patient experiencing a specific clinical event. The model was evaluated using the receiver operating characteristic (ROC) curve. Results Of the 130 patients included, the mean age was 54. Univariate analysis identified the following as risk factors for EGV rebleeding in cirrhosis: Age ( p  = 0.034), Erythrocyte(RBC)( p  < 0.001), Lymphocyte (LYM )( p  = 0.031), Red Cell Distribution Width-Coefficient of Variation (RDW-CV) ( p  = 0.004), Red Blood Cell Distribution width coefficient of variation to Lymphocyte ratio ( p  = 0.005), Neutrophil-to-Lymphocyte ratio(NLR) ( p  < 0.001), Creatine Kinase Isoenzyme (CK-MB) ( p  = 0.034), Urea Nitrogen (BUN)( p  < 0.001), Total Cholesterol (TC) ( p  = 0.001), Procalcitonin༈PCT༉ ( p  < 0.001), Ascites ( p  < 0.001), and Thickening of the gallbladder wall༈TGBW༉( p  < 0.001). Indicators with statistically significant differences in the univariate analysis were included in Lasso regression, and a total of 4 predictors were selected: BUN, ascites, RBC, and TGBW. Multivariate Logistic regression analysis showed that BUN (OR = 1.116, P = 0.013), RBC (OR = 0.519, P  = 0.009), ascites (OR = 0.235, P  = 0.001), and TGBW (OR = 0.199, P  < 0.001) were independent influencing factors for rebleeding. This indicates that increased BUN, decreased RBC, presence of ascites, and TGBW increase the incidence of EGV rebleeding. Conclusion (1) RBC, BUN, ascites, and TGBW are independent risk factors for EGV rebleeding in cirrhosis. (2) A nomogram for predicting the risk of EGV rebleeding was established.