Prediction of effective percutaneous transhepatic biliary drainage in patients with hepatocellular carcinoma: A multi-central retrospective study

Background and aim: Percutaneous transhepatic biliary drainage (PTBD) does not always lead to a reduction in serum total bilirubin (TBil) level in patients with hepatocellular carcinoma and obstructive jaundice. We aimed to develop a model for pre-PTBD prediction of post-procedural TBil decrease in these patients. Materials and methods: Retrospective database searches were conducted at four teaching hospitals (reference period: January 2010 to December 2018), and baseline characteristics of eligible patients were extracted. Any decrease in TBil after PTBD and the lowest level of TBil post-PTBD <5 mg/dL, 3 mg/dL, and 2 mg/dL were each taken as the standard of effectiveness for computation of its own predictive nomogram. For data dimension decrease and feature selection, the least absolute shrinkage and selection operator (LASSO) regression model was used. A multivariable logistic regression analysis was used to develop nomograms. Each nomogram's performance was internally evaluated for its calibration, discriminative ability, and clinical usefulness. Results: Included in the study were 138 patients. The model for end-stage liver disease (MELD) score, platelet count, and portal vein thrombosis (PVT) were predictors in the nomogram for any decrease in TBil; international normalized ratio (INR), MELD score, platelet count, and PVT were predictors for a decrease to <5 mg/dL; MELD score, cholinesterase level (CHE), platelet count, and PVT were predictors for a decrease to <3 mg/dL; and MELD score, CHE, platelet count, and pre-albumin level were predictors for a decrease to <2 mg/dL. The clinical value of the nomograms was proven by decision curve analysis. Conclusions: These models may help inform clinical decision making for performing PTBD procedures.