Predictive value of soluble CD163 combined with Charlson index for esophageal variceal bleeding in patients with liver cirrhosis

doi:10.3969/j.issn.1673-8640.2024.01.004

Abstract

Abstract:

Objective To investigate the predictive value of soluble CD163（sCD163） combined with Charlson index for esophageal variceal bleeding in patients with liver cirrhosis. Methods Totally，100 patients with liver cirrhosis from Jinhua Hospital of Zhejiang University School of Medicine from April 2016 to April 2018 were enrolled as modeling group. The general data and clinical laboratory determination results were collected. According to whether esophageal variceal bleeding occurred during the follow-up period，they were classified into bleeding group（32 cases） and non-bleeding group（68 cases）. Another 50 patients with liver cirrhosis from Jinhua Hospital of Zhejiang University School of Medicine from June 2018 to June 2020 were enrolled as validation group. Logistic regression analysis was used to evaluate the risk factors for esophageal variceal bleeding in patients with liver cirrhosis. A column chart model was established，and a validation group for external validation was used. Receiver operating characteristic（ROC） curve and calibration curve were used to evaluate the discrimination and accuracy of the column chart model. ROC curve was used to evaluate the efficacy of single and combined determinations of sCD163 and Charlson index in determining esophageal variceal bleeding in patients with liver cirrhosis. Results There was no statistical significance in general data and clinical laboratory determination results between modeling group and validation group（P>0.05）. The incidence of hepatic ascites，degree of esophageal varices，red sign，portal vein diameter，splenic vein diameter，Charlson index，prothrombin time（PT），sCD163 and D-dimer（DD） levels in bleeding group were higher than those in non-bleeding group（P<0.05），and there was no statistical significance in the other indicators between the 2 groups（P>0.05）. The presence of hepatic ascites，severe esophageal varices，red sign and increased portal vein diameter，sCD163 and Charlson index were risk factors for esophageal variceal bleeding in patients with liver cirrhosis [odds ratios（OR） were 2.124 ， 1.865 ， 2.001 ， 2.412 ，1.685 and 2.623 ，95% confidence intervals（CI） were 1.235-3.024 ， 1.425-2.563 ， 1.121-3.221 ， 1.785-3.500 ， 1.247-2.875 and 2.013-3.245，respectively]. The areas under curves for single and combined determinations of sCD163 and Charlson index to determine esophageal variceal bleeding in patients with liver cirrhosis were 0.846，0.852 and 0.889，respectively. The ROC curve and calibration curve both showed that the constructed column chart model had good discrimination and accuracy. Conclusions The combined determination of sCD163 and Charlson index has good predictive value for esophageal variceal bleeding in patients with liver cirrhosis.

Key words: Soluble CD163, Charlson index, Esophageal varix, Liver cirrhosis, Column chart model

CLC Number:

R446.1

ZHANG Yang, ZHANG Dehe, TANG Shiyue, ZHANG Jun, WANG Jianming, CHEN Ling. Predictive value of soluble CD163 combined with Charlson index for esophageal variceal bleeding in patients with liver cirrhosis[J]. Laboratory Medicine, 2024, 39(1): 19-25.

Figures/Tables 7

References 24

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组别	例数	性别		年龄/岁	肝硬化病因			肝腹水/ 例	食管静脉曲张程度
组别	例数	男/例	女/例	年龄/岁	乙型肝炎/例	乙醇型/例	胆汁型/例	肝腹水/ 例	中度/例	重度/例
建模组	100	60	40	52.27±12.81	63	21	16	40	40	60
验证组	50	32	18	53.46±13.17	36	8	6	19	22	28
统计值		0.225		0.531	1.204			0.056	0.22
P值		0.635		0.596	0.548			0.813	0.639
组别	红色征/例		门静脉内径/cm	食管静脉曲张出血/例	脾静脉内径/cm		ALT/	AST/	PT/s	APTT/s
组别	红色征/例		门静脉内径/cm	食管静脉曲张出血/例	脾静脉内径/cm		（U·L^-1）	（U·L^-1）	PT/s	APTT/s
建模组	37		1.25±0.18	32	1.00±0.10		59.00±14.47	76.66±15.73	17.05±3.07	37.74±6.06
验证组	11		1.20±0.16	14	1.02±0.12		59.23±13.51	76.89±15.62	16.88±3.01	38.65±5.76
统计值	3.447		1.663	0.251	1.079		0.094	0.085	0.322	0.881
P值	0.063		0.099	0.616	0.282		0.925	0.933	0.748	0.38
组别	PLT计数/（×10⁹/L）		Alb/（g·L-1）		TB/（mmol·L^-1）		Cr/（mmol·L^-1）	sCD163/（mg·L^-1）	DD/	Charlson指数/分
组别	PLT计数/（×10⁹/L）		Alb/（g·L-1）		TB/（mmol·L^-1）		Cr/（mmol·L^-1）	sCD163/（mg·L^-1）	（mg·L^-1）	Charlson指数/分
建模组	85.74±10.10		26.51±4.89		10.23±2.85		52.76±6.53	2.92±0.58	16.27±3.88	2.41±0.61
验证组	86.23±10.67		27.31±4.98		10.19±3.02		52.85±6.78	2.85±0.47	15.85±3.64	2.33±0.50
统计值	0.275		0.939		0.531		1.604	0.74	0.638	0.802
P值	0.784		0.349		0.596		0.111	0.46	0.525	0.424

组别	例数	性别		年龄/岁	肝硬化病因			肝腹水/ 例	食管静脉曲张程度
组别	例数	男/例	女/例	年龄/岁	乙型肝炎/例	乙醇型/例	胆汁型/例	肝腹水/ 例	中度/例	重度/例
建模组	100	60	40	52.27±12.81	63	21	16	40	40	60
验证组	50	32	18	53.46±13.17	36	8	6	19	22	28
统计值		0.225		0.531	1.204			0.056	0.22
P值		0.635		0.596	0.548			0.813	0.639
组别	红色征/例		门静脉内径/cm	食管静脉曲张出血/例	脾静脉内径/cm		ALT/	AST/	PT/s	APTT/s
组别	红色征/例		门静脉内径/cm	食管静脉曲张出血/例	脾静脉内径/cm		（U·L^-1）	（U·L^-1）	PT/s	APTT/s
建模组	37		1.25±0.18	32	1.00±0.10		59.00±14.47	76.66±15.73	17.05±3.07	37.74±6.06
验证组	11		1.20±0.16	14	1.02±0.12		59.23±13.51	76.89±15.62	16.88±3.01	38.65±5.76
统计值	3.447		1.663	0.251	1.079		0.094	0.085	0.322	0.881
P值	0.063		0.099	0.616	0.282		0.925	0.933	0.748	0.38
组别	PLT计数/（×10⁹/L）		Alb/（g·L-1）		TB/（mmol·L^-1）		Cr/（mmol·L^-1）	sCD163/（mg·L^-1）	DD/	Charlson指数/分
组别	PLT计数/（×10⁹/L）		Alb/（g·L-1）		TB/（mmol·L^-1）		Cr/（mmol·L^-1）	sCD163/（mg·L^-1）	（mg·L^-1）	Charlson指数/分
建模组	85.74±10.10		26.51±4.89		10.23±2.85		52.76±6.53	2.92±0.58	16.27±3.88	2.41±0.61
验证组	86.23±10.67		27.31±4.98		10.19±3.02		52.85±6.78	2.85±0.47	15.85±3.64	2.33±0.50
统计值	0.275		0.939		0.531		1.604	0.74	0.638	0.802
P值	0.784		0.349		0.596		0.111	0.46	0.525	0.424

组别	例数	性别		年龄/岁	肝硬化病因			肝腹水/ 例	食管静脉曲张程度
组别	例数	男/例	女/例	年龄/岁	乙型肝炎/例	乙醇型/例	胆汁型/例	肝腹水/ 例	中度/例	重度/例
出血组	32	20	12	52.67±12.39	22	6	4	18	8	24
未出血组	68	40	28	51.86±13.22	41	15	12	22	32	36
统计值		0.123		0.291	0.721			5.178	4.412
P值		0.726		0.771	0.697			0.023	0.036
组别	红色征/例		门静脉内径/cm	脾静脉内径/cm		ALT/（U·L^-1）	AST/（U·L^-1）		PT/s	APTT/s
出血组	26		1.38±0.20	1.08±0.12		58.12±14.26	74.62±14.87		17.82±3.26	37.62±6.23
未出血组	11		1.11±0.16	0.91±0.08		60.88±14.67	78.69±16.58		16.27±2.88	37.85±5.89
统计值	39.53		7.253	8.391		0.885	1.182		2.406	0.179
P值	0		0	0		0.378	0.24		0.018	0.858
组别	PLT计数/（×10⁹/L）		Alb/ （g·L^-1）	TB/（mmol·L^-1）		Cr/（mmol·L^-1）	sCD163/（mg·L^-1）		DD/ （mg·L^-1）	Charlson指数/分
出血组	76.25±8.76		24.65±4.56	9.27±1.38		53.41±6.22	3.52±0.72		17.68±4.63	2.56±0.78
未出血组	95.23±11.43		28.36±5.21	11.56±3.62		51.98±5.79	2.31±0.43		14.86±3.12	2.26±0.43
统计值	8.307		3.452	3.456		1.177	10.474		3.589	2.478
P值	0		0.001	0.001		0.242	0		0.001	0.015

组别	例数	性别		年龄/岁	肝硬化病因			肝腹水/ 例	食管静脉曲张程度
组别	例数	男/例	女/例	年龄/岁	乙型肝炎/例	乙醇型/例	胆汁型/例	肝腹水/ 例	中度/例	重度/例
出血组	32	20	12	52.67±12.39	22	6	4	18	8	24
未出血组	68	40	28	51.86±13.22	41	15	12	22	32	36
统计值		0.123		0.291	0.721			5.178	4.412
P值		0.726		0.771	0.697			0.023	0.036
组别	红色征/例		门静脉内径/cm	脾静脉内径/cm		ALT/（U·L^-1）	AST/（U·L^-1）		PT/s	APTT/s
出血组	26		1.38±0.20	1.08±0.12		58.12±14.26	74.62±14.87		17.82±3.26	37.62±6.23
未出血组	11		1.11±0.16	0.91±0.08		60.88±14.67	78.69±16.58		16.27±2.88	37.85±5.89
统计值	39.53		7.253	8.391		0.885	1.182		2.406	0.179
P值	0		0	0		0.378	0.24		0.018	0.858
组别	PLT计数/（×10⁹/L）		Alb/ （g·L^-1）	TB/（mmol·L^-1）		Cr/（mmol·L^-1）	sCD163/（mg·L^-1）		DD/ （mg·L^-1）	Charlson指数/分
出血组	76.25±8.76		24.65±4.56	9.27±1.38		53.41±6.22	3.52±0.72		17.68±4.63	2.56±0.78
未出血组	95.23±11.43		28.36±5.21	11.56±3.62		51.98±5.79	2.31±0.43		14.86±3.12	2.26±0.43
统计值	8.307		3.452	3.456		1.177	10.474		3.589	2.478
P值	0		0.001	0.001		0.242	0		0.001	0.015

项目	AUC（95%CI）	最佳临界值	P值	敏感性/%	特异性/%	约登指数
sCD163	0.846（0.803~0.896）	2.95 mg·L^-1	<0.001	85.26	86.03	0.713
Charlson指数	0.852（0.811~0.902）	3.00分	<0.001	86.74	85.52	0.723
联合检测	0.889（0.814~0.927）	0.17	<0.001	90.23	87.25	0.775