Zhou Xia, Gao Hong-Mei, Huang Lin, Han Hui-Wu, Hu Hong-Ling, Li You, Yu Ren-He
Department of Clinical Nursing, Xiangya Hospital, Central South University, Changsha 410008, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2025 Mar 15;27(3):321-327. doi: 10.7499/j.issn.1008-8830.2409102.
To explore the risk factors of feeding intolerance (FI) in critically ill children receiving enteral nutrition (EN) and to construct a prediction nomogram model for FI.
A retrospective study was conducted to collect data from critically ill children admitted to the Pediatric Intensive Care Unit of Xiangya Hospital, Central South University, between January 2015 and October 2020. The children were randomly divided into a training set (346 cases) and a validation set (147 cases). The training set was further divided into a tolerance group (216 cases) and an intolerance group (130 cases). Multivariate logistic regression analysis was used to screen for risk factors for FI in critically ill children receiving EN. A nomogram was constructed using R language, which was then validated on the validation set. The model's discrimination, calibration, and clinical net benefit were evaluated using receiver operating characteristic curves, calibration curves, and decision curves.
Duration of bed rest, shock, gastrointestinal decompression, use of non-steroidal anti-inflammatory drugs, and combined parenteral nutrition were identified as independent risk factors for FI in critically ill children receiving EN (<0.05). Based on these factors, a nomogram prediction model for FI in critically ill children receiving EN was developed. The area under the receiver operating characteristic curve for the training set and validation set was 0.934 (95%: 0.906-0.963) and 0.852 (95%: 0.787-0.917), respectively, indicating good discrimination of the model. The Hosmer-Lemeshow goodness-of-fit test showed that the model had a good fit (χ 2=12.559, =0.128). Calibration curve and decision curve analyses suggested that the model has high predictive efficacy and clinical application value.
Duration of bed rest, shock, gastrointestinal decompression, use of non-steroidal anti-inflammatory drugs, and combined parenteral nutrition are independent risk factors for FI in critically ill children receiving EN. The nomogram model developed based on these factors exhibits high predictive efficacy and clinical application value.
探讨接受肠内营养（EN）的危重症儿童发生喂养不耐受（FI）的危险因素，并构建FI的预测列线图模型。
进行一项回顾性研究，收集2015年1月至2020年10月期间在中南大学湘雅医院儿科重症监护病房收治的危重症儿童的数据。将这些儿童随机分为训练集（346例）和验证集（147例）。训练集进一步分为耐受组（216例）和不耐受组（130例）。采用多因素logistic回归分析筛选接受EN的危重症儿童发生FI的危险因素。使用R语言构建列线图，然后在验证集上进行验证。采用受试者工作特征曲线、校准曲线和决策曲线评估模型的区分度、校准度和临床净效益。
卧床时间、休克、胃肠减压、使用非甾体类抗炎药和联合肠外营养被确定为接受EN的危重症儿童发生FI的独立危险因素（<0.05）。基于这些因素，建立了接受EN的危重症儿童FI的列线图预测模型。训练集和验证集的受试者工作特征曲线下面积分别为0.934（95%：0.906 - 0.963）和0.852（95%：0.787 - 0.917），表明模型具有良好的区分度。Hosmer-Lemeshow拟合优度检验显示模型拟合良好（χ2 = 12.559，P = 0.128）。校准曲线和决策曲线分析表明该模型具有较高的预测效能和临床应用价值。
卧床时间、休克、胃肠减压、使用非甾体类抗炎药和联合肠外营养是接受EN的危重症儿童发生FI的独立危险因素。基于这些因素建立的列线图模型具有较高的预测效能和临床应用价值。
