Development and validation of a nomogram for predicting catheter-related complications after percutaneous...

ObjectiveTo identify predictors of 30-day catheter-related complications after percutaneous transhepatic cholangial drainage in patients with malignant obstructive jaundice and to develop and internally validate an individualized risk-prediction nomogram.MethodsThis single-center retrospective study included consecutive patients with malignant obstructive jaundice who underwent percutaneous transhepatic cholangial drainage between January 2020 and December 2025. The primary outcome was the occurrence of catheter-related complications within 30 days after percutaneous transhepatic cholangial drainage. Univariable and multivariable logistic regression analyses were used to identify candidate predictors and construct the final model. Model performance was assessed using the area under the receiver operating characteristic curve, calibration analysis, the Hosmer-Lemeshow goodness-of-fit test, the Brier score, decision curve analysis, and bootstrap internal validation with 1000 resamples.ResultsA total of 380 patients were included, of whom 122 (32.1%) developed catheter-related complications within 30 days. The final model incorporated prior biliary intervention, high biliary obstruction, ascites, C-reactive protein level, bilateral drainage, and catheter size. Prior biliary intervention (adjusted odds ratio = 2.06; 95% confidence interval: 1.24-3.42), ascites (adjusted odds ratio = 1.88; 95% confidence interval: 1.12-3.15), and higher C-reactive protein level (adjusted odds ratio per 10 mg/L increase, 1.19; 95% confidence interval: 1.09-1.30) were associated with an increased risk of complications, whereas larger catheter size was associated with a lower risk (adjusted odds ratio per 2-Fr increase, 0.60; 95% confidence interval: 0.40-0.92). The nomogram achieved an area under the receiver operating characteristic curve of 0.710, an optimism-corrected area under the receiver operating characteristic curve of 0.688, and a Brier score of 0.192. Calibration was satisfactory, with no evidence of poor fit (Hosmer-Lemeshow p = 0.923). Decision curve analysis indicated potential clinical net benefit across relevant threshold probabilities.ConclusionsCatheter-related complications were common after percutaneous transhepatic cholangial drainage. A nomogram based on routinely available clinical, inflammatory, and procedural variables showed acceptable internal performance and may assist in the early identification and targeted management of patients at high risk.