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A nomogram for predicting postoperative intra-abdominal hypertension in pediatric patients following liver
ZhiRu Li1,2, FangYan Lu1,3, YanHong Dai3
1Department of Nursing, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, Zhejiang, China.
Insights
This study developed a nomogram to detect early intra-abdominal hypertension (IAH) in pediatric liver transplant (LT) patients. The tool uses Graft-to-Recipient Weight Ratio, mechanical ventilation duration, and central venous pressure for risk assessment.
Area of Science:
- Pediatric critical care medicine
- Transplant surgery
- Abdominal medicine
Background:
- Intra-abdominal hypertension (IAH) is a significant complication in pediatric liver transplant (LT) recipients.
- Early detection of IAH is crucial for improving patient outcomes and reducing morbidity.
- Current methods for IAH detection may lack specificity or timeliness in this vulnerable population.
Purpose of the Study:
- To develop and validate a predictive nomogram for the early detection of intra-abdominal hypertension (IAH) in pediatric patients undergoing liver transplantation (LT).
- To identify key perioperative predictors associated with the development of IAH post-LT.
- To provide a clinically applicable tool for risk stratification and timely intervention.
Main Methods:
- A prospective, observational study involving 425 pediatric LT recipients in a tertiary hospital's Liver Transplantation Intensive Care Unit (LICU).
- Data on perioperative parameters were collected electronically, and intra-abdominal pressure (IAP) was measured using the standardized transvesical technique.
- A LASSO regression model identified predictors, which were integrated into a multivariable logistic regression nomogram, internally validated for discrimination (AUC), calibration (Hosmer-Lemeshow), and clinical utility (DCA).
Main Results:
- A nomogram was constructed using three significant predictors: Graft-to-Recipient Weight Ratio (GRWR), duration of mechanical ventilation (MV), and central venous pressure (CVP).
- The nomogram demonstrated high predictive accuracy (AUC = 0.831) with adequate calibration (p > 0.05) and favorable clinical utility across various probability thresholds.
- Temporal validation confirmed the nomogram's reliability, maintaining a strong discriminative capacity (AUC = 0.822).
Conclusions:
- An effective nomogram was developed for identifying pediatric liver transplant patients at high risk for developing intra-abdominal hypertension (IAH).
- The nomogram incorporates GRWR, duration of MV, and CVP, offering a practical tool for early IAH detection.
- This tool can aid clinicians in timely intervention, potentially improving outcomes for pediatric LT recipients.
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.
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