Department of Anesthesia and Perioperative Medicine, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan City, Ningxia, China.
BMC Anesthesiol. 2024 Jul 4;24(1):222. doi: 10.1186/s12871-024-02598-3.
Transfer to the ICU is common following non-cardiac surgeries, including radical colorectal cancer (CRC) resection. Understanding the judicious utilization of costly ICU medical resources and supportive postoperative care is crucial. This study aimed to construct and validate a nomogram for predicting the need for mandatory ICU admission immediately following radical CRC resection.
Retrospective analysis was conducted on data from 1003 patients who underwent radical or palliative surgery for CRC at Ningxia Medical University General Hospital from August 2020 to April 2022. Patients were randomly assigned to training and validation cohorts in a 7:3 ratio. Independent predictors were identified using the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression in the training cohort to construct the nomogram. An online prediction tool was developed for clinical use. The nomogram's calibration and discriminative performance were assessed in both cohorts, and its clinical utility was evaluated through decision curve analysis (DCA).
The final predictive model comprised age (P = 0.003, odds ratio [OR] 3.623, 95% confidence interval [CI] 1.535-8.551); nutritional risk screening 2002 (NRS2002) (P = 0.000, OR 6.129, 95% CI 2.920-12.863); serum albumin (ALB) (P = 0.013, OR 0.921, 95% CI 0.863-0.982); atrial fibrillation (P = 0.000, OR 20.017, 95% CI 4.191-95.609); chronic obstructive pulmonary disease (COPD) (P = 0.009, OR 8.151, 95% CI 1.674-39.676); forced expiratory volume in 1 s / Forced vital capacity (FEV1/FVC) (P = 0.040, OR 0.966, 95% CI 0.935-0.998); and surgical method (P = 0.024, OR 0.425, 95% CI 0.202-0.891). The area under the curve was 0.865, and the consistency index was 0.367. The Hosmer-Lemeshow test indicated excellent model fit (P = 0.367). The calibration curve closely approximated the ideal diagonal line. DCA showed a significant net benefit of the predictive model for postoperative ICU admission.
Predictors of ICU admission following radical CRC resection include age, preoperative serum albumin level, nutritional risk screening, atrial fibrillation, COPD, FEV1/FVC, and surgical route. The predictive nomogram and online tool support clinical decision-making for postoperative ICU admission in patients undergoing radical CRC surgery.
Despite the retrospective nature of this study, we have proactively registered it with the Chinese Clinical Trial Registry. The registration number is ChiCTR2200062210, and the date of registration is 29/07/2022.
非心脏手术后常需转入 ICU，包括结直肠癌（CRC）根治术。了解 ICU 昂贵医疗资源的合理利用和术后支持性护理至关重要。本研究旨在构建和验证一种预测结直肠癌根治术后即刻需要强制性 ICU 入院的列线图。
对 2020 年 8 月至 2022 年 4 月宁夏医科大学总医院行结直肠癌根治术或姑息性手术的 1003 例患者的数据进行回顾性分析。患者按 7:3 的比例随机分配到训练和验证队列中。使用最小绝对收缩和选择算子（LASSO）和多变量逻辑回归在训练队列中确定独立预测因子，以构建列线图。开发了一个在线预测工具用于临床应用。在两个队列中评估列线图的校准和判别性能，并通过决策曲线分析（DCA）评估其临床实用性。
最终预测模型包括年龄（P=0.003，优势比[OR]3.623，95%置信区间[CI]1.535-8.551）；营养风险筛查 2002（NRS2002）（P=0.000，OR 6.129，95%CI 2.920-12.863）；血清白蛋白（ALB）（P=0.013，OR 0.921，95%CI 0.863-0.982）；心房颤动（P=0.000，OR 20.017，95%CI 4.191-95.609）；慢性阻塞性肺疾病（COPD）（P=0.009，OR 8.151，95%CI 1.674-39.676）；用力肺活量/用力肺活量（FEV1/FVC）（P=0.040，OR 0.966，95%CI 0.935-0.998）；和手术方式（P=0.024，OR 0.425，95%CI 0.202-0.891）。曲线下面积为 0.865，一致性指数为 0.367。Hosmer-Lemeshow 检验表明模型拟合良好（P=0.367）。校准曲线与理想对角线非常接近。DCA 表明预测模型对术后 ICU 入院有显著的净获益。
结直肠癌根治术后 ICU 入院的预测因素包括年龄、术前血清白蛋白水平、营养风险筛查、心房颤动、COPD、FEV1/FVC 和手术途径。预测列线图和在线工具支持结直肠癌根治术后 ICU 入院的临床决策。
尽管本研究具有回顾性，但我们已主动在中国临床试验注册中心进行了注册。注册号为 ChiCTR2200062210，注册日期为 2022 年 7 月 29 日。
