The First Clinical Medicine, Lanzhou University, Lanzhou, 730000, Gansu, China.
Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou, 730000, Gansu, China.
Sci Rep. 2024 Aug 25;14(1):19728. doi: 10.1038/s41598-024-70635-9.
This study aims to analyze the risk factors associated with delayed postoperative bleeding (DPPB) following colorectal polyp surgery, develop a dynamic nomogram and evaluate the model efficacy, provide a reference for clinicians to identify the patients at high risk of DPPB. Retrospective study was done on patients who underwent endoscopic colorectal polypectomy at the First Hospital of Lanzhou University from January 2020 to March 2023. Differences between the group with and without DPPB were compared, and independent risk factors for DPPB occurrence were identified through univariate analysis and combination LASSO and logistic regression. A dynamic nomogram was constructed based on multiple logistic regression to predict DPPB following colorectal polyp surgery. Model evaluation included receiver operating characteristic (ROC), Calibration curve, Decision curve analysis (DCA). DPPB occurred in 38 of the 1544 patients included. multivariate analysis showed that direct oral anticoagulants (DOACs), polyp location in the right hemi colon, polyp diameter, drink, and prophylactic hemoclips were the independent risk factors for DPPB and dynamic nomogram were established. Model validation indicated area under the ROC curve values of 0.936, 0.796, and 0.865 for the training set, validation set, and full set, respectively. The calibration curve demonstrated a strong alignment between the predictions of the column-line diagram model and actual observations. The decision curve analysis (DCA) displayed a significant net clinical benefit across the threshold probability range of 0-100%. The dynamic nomogram aids clinicians in identifying high-risk patients, enabling personalized diagnosis and treatment.
本研究旨在分析结直肠息肉切除术后迟发性术后出血(DPPB)的相关风险因素,建立动态列线图并评估模型效能,为临床医生识别 DPPB 高风险患者提供参考。回顾性分析 2020 年 1 月至 2023 年 3 月在兰州大学第一医院行内镜下结直肠息肉切除术的患者。比较 DPPB 组和非 DPPB 组之间的差异,通过单因素分析和 LASSO 结合逻辑回归识别 DPPB 发生的独立危险因素。基于多因素逻辑回归构建预测结直肠息肉切除术后 DPPB 的动态列线图。模型评估包括接受者操作特征(ROC)、校准曲线、决策曲线分析(DCA)。1544 例患者中 38 例发生 DPPB。多因素分析显示直接口服抗凝剂(DOACs)、右半结肠息肉位置、息肉直径、饮酒和预防性止血夹是 DPPB 的独立危险因素,并建立了动态列线图。模型验证显示训练集、验证集和全数据集的 ROC 曲线下面积分别为 0.936、0.796 和 0.865。校准曲线表明列线图模型的预测与实际观察之间具有很强的一致性。决策曲线分析(DCA)显示在 0-100%的阈值概率范围内具有显著的净临床获益。动态列线图有助于临床医生识别高危患者,实现个体化诊断和治疗。