BMC pediatrics · 2025
A nomogram for predicting postoperative intra-abdominal hypertension in pediatric patients following liver transplantation: a prospective observational study.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Li ZhiRu, Lu FangYan, Dai YanHong, Ji Li, Huang HaiLi, He PanPan, Zhang WanYing, Wang HuaFen
Аннотация
OBJECTIVES: To create a nomogram for early intra-abdominal hypertension (IAH) detection in pediatric patients following liver transplantation (LT).
METHODS: This prospective, observational study was conducted in a tertiary hospital's Liver Transplantation Intensive Care Unit (LICU), prospectively recruiting a cohort of 425 children undergoing liver transplantation between January 2022 and December 2024. Perioperative parameters were electronically extracted via the hospital information system. Intra-abdominal pressure (IAP) quantification employed the standardized transvesical technique. To identify clinically relevant predictors, a LASSO-based feature selection algorithm was applied, leveraging regularization to shrink coefficients of non-informative variables toward zero. The retained covariates were then integrated into a multivariable logistic regression model for nomogram construction. Internal validation included three domains: (1) discrimination performance evaluated by area under the ROC curve (AUC), (2) calibration accuracy by Hosmer-Lemeshow test with calibration curves, and (3) clinical utility assessed through decision curve analysis (DCA) across probability thresholds.
RESULTS: Three independent predictors were identified: Graft-to-Recipient Weight Ratio (GRWR), duration of mechanical ventilation (MV), and central venous pressure (CVP), integrated into a predictive nomogram. DCA showed a significant net benefit, and temporal validation confirmed the nomogram's reliability. The nomogram displayed superior predictive accuracy (AUC = 0.831) with adequate calibration (Hosmer-Lemeshow test p > 0.05). DCA revealed favorable clinical applicability across threshold probabilities, showing positive net benefit values ranging from 10%-80% and 5%-80%, while temporal validation maintained discriminative capacity (AUC = 0.822).
CONCLUSIONS: The study devised an effective nomogram for identifying pediatric patients at a heightened risk of IAH following LT, incorporating GRWR, duration of MV and CVP.
METHODS: This prospective, observational study was conducted in a tertiary hospital's Liver Transplantation Intensive Care Unit (LICU), prospectively recruiting a cohort of 425 children undergoing liver transplantation between January 2022 and December 2024. Perioperative parameters were electronically extracted via the hospital information system. Intra-abdominal pressure (IAP) quantification employed the standardized transvesical technique. To identify clinically relevant predictors, a LASSO-based feature selection algorithm was applied, leveraging regularization to shrink coefficients of non-informative variables toward zero. The retained covariates were then integrated into a multivariable logistic regression model for nomogram construction. Internal validation included three domains: (1) discrimination performance evaluated by area under the ROC curve (AUC), (2) calibration accuracy by Hosmer-Lemeshow test with calibration curves, and (3) clinical utility assessed through decision curve analysis (DCA) across probability thresholds.
RESULTS: Three independent predictors were identified: Graft-to-Recipient Weight Ratio (GRWR), duration of mechanical ventilation (MV), and central venous pressure (CVP), integrated into a predictive nomogram. DCA showed a significant net benefit, and temporal validation confirmed the nomogram's reliability. The nomogram displayed superior predictive accuracy (AUC = 0.831) with adequate calibration (Hosmer-Lemeshow test p > 0.05). DCA revealed favorable clinical applicability across threshold probabilities, showing positive net benefit values ranging from 10%-80% and 5%-80%, while temporal validation maintained discriminative capacity (AUC = 0.822).
CONCLUSIONS: The study devised an effective nomogram for identifying pediatric patients at a heightened risk of IAH following LT, incorporating GRWR, duration of MV and CVP.