HPB : the official journal of the International Hepato Pancreato Biliary Association · 2022
Predicting persistent organ failure on admission in patients with acute pancreatitis: development and validation of a mobile nomogram.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Shi Na, Zhang Xiaoxin, Zhu Yin, Deng Lihui, Li Lan, Zhu Ping, Xia Liang, Jin Tao, Ward Thomas, Sztamary Peter, Cai Wenhao, Yao Linbo, Yang Xinmin, Lin Ziqi, Jiang Kun, Guo Jia, Yang Xiaonan, Singh Vikesh K, Sutton Robert, Lu Nonghua, Windsor John A, He Wenhua, Huang Wei, Xia Qing
Аннотация
BACKGROUND: Early prediction of persistent organ failure (POF) is important for triage and timely treatment of patients with acute pancreatitis (AP).
METHODS: All AP patients were consecutively admitted within 48 h of symptom onset. A nomogram was developed to predict POF on admission using data from a retrospective training cohort, validated by two prospective cohorts. The clinical utility of the nomogram was defined by concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC), while the performance by post-test probability.
RESULTS: There were 816, 398, and 880 patients in the training, internal and external validation cohorts, respectively. Six independent predictors determined by logistic regression analysis were age, respiratory rate, albumin, lactate dehydrogenase, oxygen support, and pleural effusion and were included in the nomogram (web-based calculator: https://shina.shinyapps.io/DynNomapp/). This nomogram had reasonable predictive ability (C-indexes 0.88/0.91/0.81 for each cohort) and promising clinical utility (DCA and CIC). The nomogram had a positive likelihood ratio and post-test probability of developing POF in the training, internal and external validation cohorts of 4.26/31.7%, 7.89/39.1%, and 2.75/41%, respectively, superior or equal to other prognostic scores.
CONCLUSIONS: This nomogram can predict POF of AP patients and should be considered for clinical practice and trial allocation.
METHODS: All AP patients were consecutively admitted within 48 h of symptom onset. A nomogram was developed to predict POF on admission using data from a retrospective training cohort, validated by two prospective cohorts. The clinical utility of the nomogram was defined by concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC), while the performance by post-test probability.
RESULTS: There were 816, 398, and 880 patients in the training, internal and external validation cohorts, respectively. Six independent predictors determined by logistic regression analysis were age, respiratory rate, albumin, lactate dehydrogenase, oxygen support, and pleural effusion and were included in the nomogram (web-based calculator: https://shina.shinyapps.io/DynNomapp/). This nomogram had reasonable predictive ability (C-indexes 0.88/0.91/0.81 for each cohort) and promising clinical utility (DCA and CIC). The nomogram had a positive likelihood ratio and post-test probability of developing POF in the training, internal and external validation cohorts of 4.26/31.7%, 7.89/39.1%, and 2.75/41%, respectively, superior or equal to other prognostic scores.
CONCLUSIONS: This nomogram can predict POF of AP patients and should be considered for clinical practice and trial allocation.