Zhang Ze, Zhao Haotian, Zhang Zhiyang, Jia Lijing, Long Ling, Fu You, Du Quansheng
Department of Intensive Care Unit, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China.
Department of Ultrasound, Hebei General Hospital, Shijiazhuang, Hebei, People's Republic of China.
J Inflamm Res. 2025 Jan 7;18:221-236. doi: 10.2147/JIR.S496559. eCollection 2025.
Acute respiratory distress syndrome (ARDS) is a severe form of organ dysfunction and a common postoperative complication. This study aims to develop a predictive model for ARDS in postoperative patients with gastrointestinal perforation to facilitate early detection and effective prevention.
In this single-center retrospective study, clinical data were collected from postoperative patients with gastrointestinal perforation admitted to the ICU in Hebei Provincial People's Hospital from October 2017 to May 2024. Univariate analysis and multifactorial logistic regression analysis were used to determine the independent risk factors for developing ARDS. Nomograms were developed to show predictive models, and the discrimination, calibration, and clinical usefulness of the models were assessed using the C-index, calibration plots, and decision curve analysis (DCA).
Two hundred patients were ultimately included for analysis. In the development cohort, 38 (27.1%) of 140 patients developed ARDS, and in the internal validation cohort, 13 (21.7%) of 60 patients developed ARDS. The multivariate logistic regression analysis revealed the site of perforation (OR = 0.164, P = 0.006), the duration of surgery (OR = 0.986, P = 0.008), BMI (OR = 1.197, P = 0.015), SOFA (OR = 1.443, P = 0.001), lactate (OR = 1.500, P = 0.017), and albumin (OR = 0.889, P = 0.007) as the independent risk factors for ARDS development. The area under the curve (AUC) was 0.921 (95% CI: 0.869, 0.973) for the development cohort and 0.894 (95% CI: 0.809, 0.978) for the validation cohort. The calibration curve and decision curve analysis (DCA) demonstrate that the nomogram possesses good predictive value and clinical practicability.
Our research introduced a nomogram that integrates six independent risk factors, facilitating the precise prediction of ARDS risk in postoperative patients following gastrointestinal perforation.
急性呼吸窘迫综合征（ARDS）是一种严重的器官功能障碍形式，也是常见的术后并发症。本研究旨在建立一种针对胃肠道穿孔术后患者发生ARDS的预测模型，以促进早期发现和有效预防。
在这项单中心回顾性研究中，收集了2017年10月至2024年5月在河北省人民医院重症监护病房收治的胃肠道穿孔术后患者的临床资料。采用单因素分析和多因素逻辑回归分析来确定发生ARDS的独立危险因素。绘制列线图以展示预测模型，并使用C指数、校准图和决策曲线分析（DCA）评估模型的辨别力、校准度和临床实用性。
最终纳入200例患者进行分析。在开发队列中，140例患者中有38例（27.1%）发生ARDS，在内部验证队列中，60例患者中有13例（21.7%）发生ARDS。多因素逻辑回归分析显示穿孔部位（OR = 0.164，P = 0.006）、手术时长（OR = 0.986，P = 0.008）、体重指数（BMI）（OR = 1.197，P = 0.015）、序贯器官衰竭评估（SOFA）评分（OR = 1.443，P = 0.001）、乳酸（OR = 1.500，P = 0.017）和白蛋白（OR = 0.889，P = 0.007）是发生ARDS的独立危险因素。开发队列的曲线下面积（AUC）为0.921（95%CI：0.869，0.973），验证队列的AUC为0.894（95%CI：0.809，0.978）。校准曲线和决策曲线分析（DCA）表明列线图具有良好的预测价值和临床实用性。
我们的研究引入了一种整合六个独立危险因素的列线图，有助于精确预测胃肠道穿孔术后患者发生ARDS的风险。
