Risk factor analysis and nomogram prediction model construction for NEC complicated by intestinal perforation

Area of Science:

• Neonatal Medicine
• Gastroenterology
• Surgical Pediatrics

Background:

• Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease in neonates.
• Intestinal perforation is a critical complication of NEC, significantly increasing mortality.
• Accurate prediction of intestinal perforation in NEC is crucial for timely intervention.

Purpose of the Study:

• To identify clinical characteristics associated with intestinal perforation in neonates diagnosed with NEC.
• To develop and validate a predictive model for the incidence of intestinal perforation in NEC patients.

Main Methods:

• Retrospective analysis of clinical data from 180 neonates with NEC.
• Comparison of clinical characteristics between neonates with and without intestinal perforation.
• Logistic and LASSO regression for identifying independent risk factors.
• Development of a nomogram prediction model using R software.
• Validation of the model using ROC curves, calibration curves, and decision curve analysis.

Main Results:

• The incidence of intestinal perforation in NEC was 26.67%.
• Independent risk factors for intestinal perforation included bloody stool (OR=5.60), APTT ≥ 50 s (OR=3.22), thrombocytopenia (OR=4.74), and hypoalbuminemia (OR=5.56).
• The nomogram model achieved a C-index of 0.838, with AUCs of 0.838 (training) and 0.802 (validation), demonstrating good predictive ability and clinical utility.

Conclusions:

• Bloody stool, prolonged APTT, thrombocytopenia, and hypoalbuminemia are significant independent risk factors for predicting intestinal perforation in NEC.
• The developed nomogram model offers a valuable tool for accurately identifying NEC patients at high risk of intestinal perforation.