Zhang Haoyun, Meng Fanyu, Lu Shichun
Department of Hepatobiliary Surgery, First Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Chinese PLA Medical School, Beijing 100853, China.
Gastroenterol Res Pract. 2020 Aug 1;2020:9761878. doi: 10.1155/2020/9761878. eCollection 2020.
Sepsis is a severe complication in patients following major hepatobiliary and pancreatic surgery. The purpose of this study was to develop and validate a nomogram based on inflammation biomarkers and clinical characteristics.
Patients who underwent major hepatobiliary and pancreatic surgery between June 2015 and April 2017 were retrospectively collected. Multivariate logistic regression was used to identify the independent risk factors associated with postoperative sepsis. A training cohort of 522 patients in an earlier period was used to develop the prediction models, and a validation cohort of 136 patients thereafter was used to validate the nomograms.
Sepsis developed in 55 of 522 patients of the training cohort and 19 of 136 patients in the validation cohort, respectively. In the training cohort, one nomogram based on clinical characteristics was developed. The clinical independent risk factors for postoperative sepsis include perioperative blood transfusion, diabetes, operative time, direct bilirubin, and BMI. Another nomogram was based on both clinical characteristics and inflammation biomarkers. Multivariate regression analyses showed that previous clinical risk factors, PCT, and CRP were independent risk factors for postoperative sepsis. The last nomogram showed a good -index of 0.844 (95% CI, 0.787-0.900) compared with the previous one of 0.777 (95% CI, 0.713-0.840). Patients with a total score more than 109 in the second model are at high risk. The positive predictive value and negative predictive value of the second nomogram were 27% and 97%, respectively.
The nomogram achieved good performances for predicting postoperative sepsis in patients by combining clinical and inflammation risk factors. This model can provide the early risk estimation of sepsis for patients following major hepatobiliary and pancreatic surgery.
脓毒症是肝胆胰大手术后患者的一种严重并发症。本研究的目的是开发并验证一种基于炎症生物标志物和临床特征的列线图。
回顾性收集2015年6月至2017年4月期间接受肝胆胰大手术的患者。采用多因素逻辑回归分析确定与术后脓毒症相关的独立危险因素。前期522例患者组成训练队列用于构建预测模型，随后136例患者组成验证队列用于验证列线图。
训练队列的522例患者中有55例发生脓毒症，验证队列的136例患者中有19例发生脓毒症。在训练队列中，构建了一个基于临床特征的列线图。术后脓毒症的临床独立危险因素包括围手术期输血、糖尿病、手术时间、直接胆红素和体重指数。另一个列线图基于临床特征和炎症生物标志物。多因素回归分析显示，既往临床危险因素、降钙素原（PCT）和C反应蛋白（CRP）是术后脓毒症的独立危险因素。最后一个列线图的C指数为0.844（95%CI，0.787-0.900），而前一个为0.777（95%CI，0.713-0.840）。第二个模型总分超过109分的患者为高危患者。第二个列线图的阳性预测值和阴性预测值分别为27%和97%。
该列线图通过结合临床和炎症危险因素，在预测患者术后脓毒症方面表现良好。该模型可为肝胆胰大手术后患者提供脓毒症的早期风险评估。
