Department of General Surgery.
Department of Emergency Medicine, University of Health Sciences, Umraniye Education and Research Hospital, Istanbul, Turkey.
Surg Laparosc Endosc Percutan Tech. 2024 Aug 1;34(4):424-431. doi: 10.1097/SLE.0000000000001300.
It might not be possible to achieve the desired outcome in every patient following bariatric surgery, even though every patient is thoroughly examined before surgery. This study aimed to develop a regression model based on parameters that affect weight loss success in patients scheduled for laparoscopic sleeve gastrectomy (LSG) and thus preoperatively predict whether the patients will have an optimal clinical response in terms of weight loss at the end of the first year.
Between January 2018 and August 2022, patients who underwent LSG were analyzed retrospectively. Age, sex, comorbidities, smoking status, alcohol use status, preoperative weight, preoperative body mass index (BMI), preoperative laboratory data, weight, and total weight loss (TWL)% values at the end of the first year were recorded. At the end of the first year following LSG, patients with TWL% above 20% were defined as having an optimal clinical response in terms of weight loss. This study is designed, conducted, and reported regarding the "transparent reporting of a multivariable prediction model for individual prognosis or diagnosis" (TRIPOD) statement. The final model was used to construct an Excel-based calculator.
Four hundred thirty-eight patients underwent the sleeve gastrectomy procedure, and 38 of them were excluded from the study because of a lack of 1-year follow-up information, resulting in 400 eligible patients for our study. Age, glucose, thyroid stimulating hormone (TSH), alcohol consumption, systemic immune inflammation index (SII), and tobacco were the independent predictors of optimal clinical response ( P <0.001, P <0.001, P <0.001, P =0.011, P =0.039, P =0.045, respectively). The model was called the GAASThyriC score. When the final model was tested in the validation cohort, the AUC was 0.875 (95% CI, 0.742-0.999), the sensitivity was 83.3% (95% CI, 51.6-97.9), specificity was 86.4% (95% CI, 77.4-92.8), negative likelihood ratio was 0.19 (95% CI, 0.05-0.68), and accuracy was 86% (95% CI, 77.6-92.1) when the cutoff value was set to the optimal threshold (logit = 0.8451).
The GAASThyriC score can be used as an effective auxiliary tool to predict the patient population with suboptimal clinical response in terms of TWL% at the end of the first year after LSG.
即使在手术前对每位患者进行了彻底检查，也可能无法使每位患者在接受减重手术后都达到预期的效果。本研究旨在建立一个基于影响腹腔镜袖状胃切除术（LSG）患者减重效果的参数的回归模型，从而在术前预测患者在术后第一年结束时的体重减轻是否会有理想的临床反应。
回顾性分析 2018 年 1 月至 2022 年 8 月间接受 LSG 的患者。记录患者年龄、性别、合并症、吸烟状况、饮酒状况、术前体重、术前体重指数（BMI）、术前实验室数据、术后第一年结束时的体重和总减重（TWL）%值。LSG 术后第一年结束时，TWL%值超过 20%的患者被定义为体重减轻具有理想的临床反应。本研究是根据“多变量预测个体预后或诊断模型的透明报告”（TRIPOD）声明进行设计、实施和报告的。最终模型用于构建基于 Excel 的计算器。
438 例患者接受了袖状胃切除术，其中 38 例因缺乏 1 年随访信息而被排除在研究之外，因此有 400 例符合条件的患者纳入本研究。年龄、血糖、促甲状腺激素（TSH）、饮酒、全身免疫炎症指数（SII）和吸烟是理想临床反应的独立预测因素（P<0.001，P<0.001，P<0.001，P=0.011，P=0.039，P=0.045，分别）。该模型称为 GAASThyriC 评分。当最终模型在验证队列中进行测试时，AUC 为 0.875（95%CI，0.742-0.999），敏感性为 83.3%（95%CI，51.6-97.9），特异性为 86.4%（95%CI，77.4-92.8），阴性似然比为 0.19（95%CI，0.05-0.68），当截值设置为最佳阈值（logit=0.8451）时，准确率为 86%（95%CI，77.6-92.1）。
GAASThyriC 评分可作为一种有效的辅助工具，预测 LSG 术后第一年结束时 TWL%值不理想的患者人群。
