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Risk factors for complications after infantile enterostomy: development of a clinical prediction model
Zhaolan Zeng1,2, Yanling Hu1,2, Shulin Hou1,2
1Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, Chengdu, China.
Insights
Infants undergoing enterostomy face high complication risks. Lower weight at surgery, small intestine stoma, and prolonged high C-reactive protein levels are key risk factors identified in a new prediction model.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Clinical Risk Prediction
Background:
- Enterostomy is a critical procedure for infants with acute abdomen.
- High incidence of short-term complications significantly impacts infant recovery.
- Identifying risk factors is crucial for improving outcomes.
Purpose of the Study:
- Identify independent risk factors for short-term complications in infants undergoing enterostomy.
- Develop and validate a predictive model for these complications.
Main Methods:
- Retrospective analysis of 155 infants who underwent enterostomy.
- Multifactorial logistic regression to identify risk factors.
- Development of a nomogram prediction model using R software.
- Validation using ROC curves, calibration curves, and decision curve analysis (DCA).
Main Results:
- Lower weight at surgery, small intestine stoma, and prolonged high C-reactive protein (CRP) were significant risk factors.
- The prediction model achieved an area under the curve (AUC) of 0.784.
- The model demonstrated good fit (Hosmer-Lemeshow p=0.604) and clinical utility.
Conclusions:
- Lower infant weight, small intestine stoma, and prolonged elevated CRP are key indicators for enterostomy complications.
- The developed prediction model offers valuable clinical utility for risk assessment.
- This tool can aid healthcare professionals in proactive management of at-risk infants.
Background:
Enterostomy is a common surgical procedure for treating acute abdomen in infants. However, the associated complication incidence is high, which significantly impacts infants' recovery. This study aimed to identify risk factors of short-term complications and develop a prediction model in infants with enterostomy.
Methods:
We retrospectively analyzed the clinical data of infants who underwent enterostomy at Sichuan University West China Second Hospital from November 2021 to June 2024. Multifactorial logistic regression analysis was used to screen the risk factors for postoperative complications related to enterostomy in infants, and R software was applied to develop a nomogram prediction model. The accuracy and clinical utility of the prediction model were verified by the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).
Results:
A total of 155 infants were included in this study, with 61 cases (39.35%) in the complication group and 94 cases (60.65%) in the non-complication group. Multifactorial logistic regression analysis showed that smaller weight at surgery (OR = 0.999, 95% CI: 0.999 ~ 1.000, p = 0.044), small intestine stoma (OR = 6.405, 95% CI: 1.647 ~ 24.916, p = 0.007), and prolonged duration of postoperative high-level C-reactive protein (CRP) (OR = 1.081, 95% CI: 1.001 ~ 1.167, p = 0.048) were independent risk factors for complications related to enterostomy in infants. The area under the curve (AUC) of the risk prediction model was 0.784 (95% CI: 0.712 ~ 0.857), and the goodness-of-fit test value of the Hosmer-Lemeshow was 0.604, higher than 0.05, indicating that the regression model had a significant fitting effect. The calibration curves and DCA demonstrated high predictive value and clinical efficiency.
Conclusion:
The smaller weight at surgery, small intestine stoma, and longer duration of postoperative high-level CRP may be used to identify the risk of short-term complications after enterostomy. This prediction model is provided for medical staff to evaluate complication-associated risk and take measures for those infants at risk.
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