Visual prediction models for predicting rebleeding events after the first esophageal variceal ligation

Sequential endoscopic variceal ligation (EVL) is a standard therapy for esophageal variceal bleeding, yet poor compliance often compromises its efficacy. This study aimed to identify high-risk factors for rebleeding after initial EVL and establish a visual predictive model to improve patient follow-up and education.

In this retrospective study, we enrolled patients who underwent first-time EVL for esophageal variceal bleeding at Xiangya Hospital, Central South University, between January 2017 and January 2023. Patients were allocated to training and validation cohorts. Clinical data were systematically collected, and rebleeding incidence rates within 6 weeks and 6 months post-EVL were analyzed. Logistic regression was used to explore high-risk factors influencing postoperative rebleeding and to establish visual models, evaluated with a validation set.

The study involved 629 patients in the training set and 312 in the validation set. Rebleeding occurred in 34.8% (219/629) and 80.1% (504/629) of patients within 6 weeks and 6 months after initial EVL, respectively. Esophageal variceal severity and platelet count emerged as shared independent risk factors for both 6-week and 6-month rebleeding. The nomogram models demonstrated robust predictive accuracy in the validation cohort, with areas under the curve (AUC) of 0.942 (95% CI 0.901-0.983) for 6-week rebleeding risk and 0.852 (95% CI 0.759-0.945) for 6-month rebleeding risk.

This study proposes a visual prediction model designed to assess the risk of rebleeding following initial EVL in patients with esophageal variceal hemorrhage to optimize clinical decision-making and improve patient management strategies.