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A nomogram for predicting the risk of Clostridioides difficile infection in children with ulcerative colitis:
Ziying Li1,2, Fumin Xue1, Jing Zhang3
1Department of Gastroenterology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China.
Insights
A new nomogram model predicts Clostridioides difficile infection (CDI) risk in pediatric ulcerative colitis (UC) patients. Key factors include PUCAI, ESR, Vitamin D, fecal calprotectin, and antibiotic duration, aiding early diagnosis.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Clinical Informatics
Background:
- Clostridioides difficile infection (CDI) is a significant concern in pediatric inflammatory bowel disease.
- Ulcerative colitis (UC) patients are at increased risk for CDI, complicating management.
- Predictive tools for CDI in pediatric UC are limited, necessitating further research.
Purpose of the Study:
- To develop and validate a dynamic nomogram model for predicting CDI risk in children with UC.
- To identify independent risk factors associated with CDI development in this population.
- To provide a clinical tool for early CDI detection and management adjustment.
Main Methods:
- Retrospective study of 121 pediatric UC patients (2018-2024).
- Patients categorized into CDI (n=35) and non-CDI (n=86) groups.
- LASSO and multivariate logistic regression identified risk factors; nomogram constructed and validated (ROC, calibration, DCA, bootstrap).
Main Results:
- Five independent risk factors for CDI identified: Pediatric Ulcerative Colitis Activity Index (PUCAI), erythrocyte sedimentation rate (ESR), vitamin D (Vit D), fecal calprotectin (FC), and antibiotic use >7 days.
- The nomogram demonstrated excellent discriminative ability (C-index = 0.964).
- Model showed good concordance, significant clinical benefit, and robust consistency across subgroups.
Conclusions:
- PUCAI, ESR, Vit D, FC, and prolonged antibiotic use are key predictors of CDI in pediatric UC.
- The developed nomogram facilitates early CDI diagnosis in children with UC.
- This tool supports timely therapeutic strategy adjustments for improved patient outcomes.
Introduction:
This study aimed to develop a dynamic nomogram model to predict the risk of Clostridioides difficile infection (CDI) in children with ulcerative colitis (UC).
Methods:
This was a retrospective study that clinical data from pediatric diagnosis and treatment with UC at Zhengzhou University Children's Hospital between January 2018 and December 2024 were retrospectively reviewed. Patients were classified into CDI (n = 35) and non-CDI (n = 86) groups based on the presence or absence of CDI. Predictor variables were selected using least absolute shrinkage and selection operator (LASSO) regression and subsequently entered into a multivariate logistic regression model. Nomograms were then constructed based on the final logistic regression analysis. The model's performance and clinical utility were assessed using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Internal validation was performed using 1,000 bootstrap resamples.
Results:
A total of 121 children were included in the study. Based on LASSO and multivariate logistic regression analysis of 24 candidate variables, five independent risk factors for CDI in children with UC were identified: Pediatric Ulcerative Colitis Activity Index (PUCAI), erythrocyte sedimentation rate (ESR), vitamin D (Vit D), fecal calprotectin (FC), and antibiotic use exceeding seven days (all p < 0.05). The nomograms constructed with the above variables demonstrated excellent discriminative ability (C-index = 0.964, 95% CI: 0.932-0.997). The Hosmer-Lemeshow test (χ2 = 12.529, p = 0.129) and bootstrap validation revealed good concordance between the predicted probabilities and actual outcomes. Decision curve analysis (DCA) indicated significant net clinical benefit, and the model maintained robust consistency across relevant clinical subgroups.
Conclusions:
PUCAI, ESR, Vit D, FC, and use of antibiotic use exceeding seven days were the five independent risk factors for CDI in children with UC. The resulting nomogram may support clinicians in early diagnosis and timely adjustment of therapeutic strategies.
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