Construction and Validation of a Risk Prediction Model for Peristomal Moisture-Associated Skin Damage in Older
Lifei Chen1, Lixia Liang1, Yuye Chen1
1Department of Anorectal Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, 323000 Lishui, Zhejiang, China.
Aim:
This study aimed to identify the risk factors for peristomal moisture-associated skin damage (PMASD) in older patients with enterostomies and to develop a predictive model.
Methods:
This is a retrospective study. Data were collected from older patients who underwent enterostomy at The Fifth Affiliated Hospital of Wenzhou Medical University in Lishui between January 2021 and December 2022. With peristomal moisture-associated skin damage as the outcome variable, predictors identified as significant in the univariate analysis were incorporated into a multivariate logistic regression model. The model's goodness-of-fit and discriminative ability were assessed using the Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve (AUC). To further evaluate the model's stability and predictive performance, an internal validation was conducted using a time-stratified cohort of 68 patients consecutively recruited from the same hospital between January 2023 and December 2023.
Results:
The incidence of PMASD was 42.59% in the model development group (n = 162) and 41.18% in the validation group (n = 68). Independent predictors of PMASD included surgical incision in the stoma baseplate area (odds ratio [OR] = 4.80; 95% confidence interval [CI], 1.04-7.51), ileostomy (OR = 3.49; 95% CI, 1.27-7.99), history of radiotherapy (OR = 1.49; 95% CI, 1.05-2.10), lack of preoperative stoma marking (OR = 5.07; 95% CI, 2.50-8.30), and peristomal skin folds (OR = 3.96; 95% CI, 2.53-16.10), while stoma height ≥1.3 cm (OR = 0.11; 95% CI, 0.04-0.29) and continuity of care (OR = 0.60; 95% CI, 0.45-0.80) were protective factors. The model showed good discrimination (area under the receiver operating characteristic curve [AUC] = 0.90; 95% CI, 0.86-0.95) and calibration (Hosmer-Lemeshow p = 0.851) in the model development group and maintained strong performance in the validation group (AUC = 0.91; Hosmer-Lemeshow p = 0.875).
Conclusions:
The validated prediction model demonstrated high discrimination (AUC >0.90) and good calibration, providing an effective tool for the early identification of older patients undergoing enterostomy at high risk of PMASD. This model may guide individualized preventive strategies and optimize the continuity of care. Further multicenter prospective studies are needed to confirm the generalizability and clinical utility of our findings.
