Huang Yao, Wu Yuhua, Jin Dongmei, Tang Qing, Yuan Peng, Lu Qi
Department of Neonatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Department of Neonatology, The General Hospital of Ningxia Medical University, Ningxia, China.
Front Pediatr. 2021 Nov 2;9:754623. doi: 10.3389/fped.2021.754623. eCollection 2021.
Information regarding the localization of gastrointestinal perforation is crucial for the following surgical procedure. This study was to determine the key indicators and develop a prediction model for the localization in neonates with gastrointestinal perforation. A nomogram to predict the location of neonatal gastrointestinal perforation was developed using a cohort of patients who underwent surgery between July 2009 and May 2021. Baseline variables were analyzed using logistics regression and nomogram developed using significant predictors. The predictive performance of the nomogram was assessed by the concordance index (C-index), calibration curve, and area under the receiver operating characteristic (ROC) curve (AUC). The nomogram was further validated in an integrated external cohort. We investigated the data of 201 patients, of which 65 (32.3%) were confirmed with upper gastrointestinal perforation by surgery. Multivariate logistic regression analysis identified the following as independent predictors: preterm [OR: 5.014 (1.492-18.922)], time of onset [OR: 0.705 (0.582-0.829)], preoperative hemoglobin [OR:1.017 (1.001-1.033)], bloody stool: No [OR: 4.860 (1.270-23.588)], shock [OR: 5.790 (1.683-22.455)] and sepsis: No [OR 3.044 (1.124-8.581)]. Furthermore, the nomogram was effective in predicting the perforation site, with an AUC of 0.876 [95% confidence interval (CI): 0.830-0.923]. Internal validation showed that the average AUC was 0.861. Additionally, the model achieved satisfactory discrimination (AUC, 0.900; 95% CI, 0.826-0.974) and calibration (Hosmer-Lemeshow test, = 0.4802) in external validation. The nomogram based on the six factors revealed good discrimination and calibration, suggesting good clinical utility. The nomogram could help surgeons predict the location of gastrointestinal perforation before surgery to make a surgical plan.
胃肠道穿孔的定位信息对于后续的外科手术至关重要。本研究旨在确定关键指标，并建立新生儿胃肠道穿孔定位的预测模型。利用2009年7月至2021年5月期间接受手术的一组患者，开发了一种预测新生儿胃肠道穿孔位置的列线图。使用逻辑回归分析基线变量，并使用显著预测因子开发列线图。通过一致性指数（C指数）、校准曲线和受试者操作特征（ROC）曲线下面积（AUC）评估列线图的预测性能。该列线图在一个综合外部队列中进一步验证。我们调查了201例患者的数据，其中65例（32.3%）经手术证实为上消化道穿孔。多因素逻辑回归分析确定以下因素为独立预测因子：早产[比值比（OR）：5.014（1.492 - 18.922）]、发病时间[OR：0.705（0.582 - 0.829）]、术前血红蛋白[OR：1.017（1.001 - 1.033）]、血便：否[OR：4.860（1.270 - 23.588）]、休克[OR：5.790（1.683 - 22.455）]和败血症：否[OR：3.044（1.124 - 8.581）]。此外，列线图在预测穿孔部位方面有效，AUC为0.876[95%置信区间（CI）：0.830 - 0.923]。内部验证显示平均AUC为0.861。此外，该模型在外部验证中实现了令人满意的区分度（AUC，0.900；95%CI，0.826 - 0.974）和校准（Hosmer - Lemeshow检验，P = 0.4802）。基于这六个因素的列线图显示出良好的区分度和校准度，表明具有良好的临床实用性。该列线图可帮助外科医生在手术前预测胃肠道穿孔的位置，以制定手术计划。
