一种用于预测梗阻性黄疸患者胰十二指肠切除术后主要并发症风险的新型列线图。

A novel nomogram for predicting the risk of major complications after pancreaticoduodenectomy in patients with obstructive jaundice.

作者信息

Shen Ziyun, Xu Zhiwei, Wang Weishen, Xu Wei, Zhou Yiran, Lu Xiongxiong, Deng Xiaxing, Weng Yuanchi, Shen Baiyong

机构信息

Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Research Institute of Pancreatic Disease, Shanghai Jiao Tong University School of Medicine, Shanghai, China; State Key Laboratory of Oncogenes and Related Genes, Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China.

出版信息

Clin Chim Acta. 2021 Jun;517:162-170. doi: 10.1016/j.cca.2021.02.018. Epub 2021 Mar 9.

DOI:10.1016/j.cca.2021.02.018

PMID:33711328

Abstract

BACKGROUND

The aim of this study was to construct and internally validate a nomogram for predicting major complications in obstructive jaundice patients planned to undergo pancreaticoduodenectomy (PD).

METHODS

The clinical data of 835 obstructive jaundice patients who underwent PD in a high-volume center were collected and retrospectively analyzed during an 8-year period. Factors affecting the major complication rate were optimized by least absolute shrinkage and selection operator (LASSO) regression analysis and were incorporated in logistic regression analysis. The performance of this nomogram was evaluated by discrimination, calibration, internal validation and clinical utility.

RESULTS

Predictors included in the model were sex, American Society of Anesthesiologists (ASA) score, preoperative biliary drainage (PBD), neutrophil-to-lymphocyte ratio (NLR), hemoglobin, prealbumin, total bilirubin, transfusion, and pathology category. The model had good discrimination and calibration with a C-index of 0.700. Internal validation generated an acceptable C-index of 0.701. Decision curve analysis indicated this nomogram was clinically useful for predicting the possibility of major complications at a threshold between 1% and 59%.

CONCLUSION

This novel nomogram could be conveniently used and assist in decisions for PBD in clinical practice.

摘要

背景

本研究旨在构建并内部验证一种用于预测计划接受胰十二指肠切除术（PD）的梗阻性黄疸患者主要并发症的列线图。

方法

收集了一家高容量中心835例接受PD的梗阻性黄疸患者的临床数据，并在8年期间进行回顾性分析。通过最小绝对收缩和选择算子（LASSO）回归分析优化影响主要并发症发生率的因素，并纳入逻辑回归分析。通过区分度、校准、内部验证和临床实用性来评估该列线图的性能。

结果

模型纳入的预测因素包括性别、美国麻醉医师协会（ASA）评分、术前胆道引流（PBD）、中性粒细胞与淋巴细胞比值（NLR）、血红蛋白、前白蛋白、总胆红素、输血情况和病理类型。该模型具有良好的区分度和校准度，C指数为0.700。内部验证产生了可接受的C指数0.701。决策曲线分析表明，该列线图在1%至59%的阈值下对于预测主要并发症的可能性在临床上是有用的。