预测胃肠手术后肺部并发症的列线图：一项回顾性研究

A nomogram to predict pulmonary complications after gastrointestinal surgery: a retrospective study.

作者信息

Zhou Chiyan, Wang Weili, Diao Yu-E

机构信息

Gastrointestinal Surgery Department 2, Jiangnan University Affiliated Hospital, Hefeng Road 1000#, Wuxi City, 214000, Jiangsu Province, China.

出版信息

BMC Gastroenterol. 2025 Apr 17;25(1):267. doi: 10.1186/s12876-025-03827-w.

DOI:10.1186/s12876-025-03827-w

PMID:40247161

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12007244/

Abstract

OBJECTIVE

We aimed at developing a nomogram able to predict postoperative pulmonary complications (PPC) after gastrointestinal surgery.

METHODS

We retrospectively analyzed the clinical data of patients who underwent gastrointestinal surgery at Jiangnan University Affiliated Hospital from December 2017 to May 2022. Patients were randomly divided into training cohort and validation cohort at a 7:3 ratio. The training cohort is divided into PPC group and Non-PPC group. The Least Absolute Shrinkage and Selection Operator (LASSO) method and logistic regression were used to determine the independent risk factors. The identified risk factors were used to construct a nomogram model for predicting the risk of PPC after gastrointestinal surgery. The nomogram model was validated by the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA).

RESULTS

A total of 563 patients were admitted. The incidence of PPC was 17.6% (99/563). In the training cohort, multiple logistic regression showed that age, hypertension, history of respiratory diseases, preoperative albumin, intraoperative blood loss, postoperative intensive care unit (ICU) time, postoperative arterial oxygen partial pressure (PaO2), and postoperative tracheal intubation time were identified as the influencing factors of PPC (P < 0.05). We constructed a nomogram model for predicting the PPC of the training cohort, with a C-index of 0.857 (95%CI 0.812-0.902). In the validation cohort, the C-index of the model is 0.936 (95%CI 0.890-0.982). The ROC curve of the training cohort is 0.875 (95%CI 0.832-0.918), similar with validation cohort 0.929 (0.876-0.982). The calibration curve indicates that the predicted results are correlated with the observed results.

CONCLUSIONS

The constructed nomogram model has certain predictive value, and can provide a scientific reference for predicting the occurrence of PPC after gastrointestinal surgery.

摘要

目的

旨在开发一种能预测胃肠手术后肺部并发症（PPC）的列线图。

方法

回顾性分析2017年12月至2022年5月在江南大学附属医院接受胃肠手术患者的临床资料。患者按7:3比例随机分为训练队列和验证队列。训练队列再分为PPC组和非PPC组。采用最小绝对收缩和选择算子（LASSO）方法及逻辑回归确定独立危险因素。将识别出的危险因素用于构建预测胃肠手术后PPC风险的列线图模型。通过受试者操作特征曲线下面积（AUC）和决策曲线分析（DCA）对列线图模型进行验证。

结果

共纳入563例患者。PPC发生率为17.6%（99/563）。在训练队列中，多因素逻辑回归显示年龄、高血压、呼吸系统疾病史、术前白蛋白、术中失血、术后重症监护病房（ICU）时间、术后动脉血氧分压（PaO2）及术后气管插管时间为PPC的影响因素（P＜0.05）。构建了训练队列PPC预测列线图模型，C指数为0.857（95%CI 0.812 - 0.902）。在验证队列中，模型C指数为0.936（95%CI 0.890 - 0.982）。训练队列的ROC曲线为0.875（95%CI 0.832 - 0.918），与验证队列的0.929（0.876 - 0.982）相似。校准曲线表明预测结果与观察结果相关。