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Published on: April 7, 2021
Risk factors and prediction model for acute respiratory distress syndrome in patients with digestive tumor after
Jie Zhen1, Wei Chen1, Yi-Fei Xu1
1Department of Intensive Care Unit, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
Background:
Postoperative acute respiratory distress syndrome (ARDS) after digestive tumors is a serious complication that severely affects patients' prognosis; however, systematic studies assessing its risk factors are lacking, and effective prediction models are urgently required.
Aim:
To investigate the risk factors for postoperative ARDS in patients with digestive tumors and construct a prediction model.
Methods:
Overall, 42 of the 176 patients developed ARDS, with an incidence rate of 23.86%. Multifactorial logistic regression analysis identified advanced age [odds ratio (OR) = 1.24, P < 0.001], smoking history (OR = 3.17, P = 0.012), preoperative lung infection (OR = 3.07, P = 0.015), low preoperative albumin level (OR = 0.71, P = 0.003), preoperative percentage of forced expiratory volume in 1 second, (OR = 0.96, P = 0.006), preoperative percentage of forced vital capacity (OR = 0.94, P = 0.012), and postoperative anastomotic fistula (OR = 4.55, P = 0.022) as independent risk factors for postoperative ARDS. The nomogram prediction model showed good discriminatory power [area under the curve (AUC) = 0.86] and goodness of fit (Hosmer-Lemeshow, P = 0.729). The internal validation demonstrated an AUC of 0.86 and a good calibration curve fit (Hosmer-Lemeshow, P = 0.914). Prospective clinical validation confirmed the reliability and clinical value of the model (AUC = 0.91, accuracy = 82.35%).
Results:
Overall, 42 of the 176 patients developed ARDS, with an incidence rate of 23.86%. Multifactorial logistic regression analysis identified advanced age (OR = 1.24, P < 0.001), smoking history (OR = 3.17, P = 0.012), preoperative lung infection (OR = 3.07, P = 0.015), low preoperative albumin level (OR = 0.71, P = 0.003), preoperative percentage of forced expiratory volume in 1 second, (OR = 0.96, P = 0.006), preoperative percentage of forced vital capacity (OR = 0.94, P = 0.012), and postoperative anastomotic fistula (OR = 4.55, P = 0.022) as independent risk factors for postoperative ARDS. The nomogram prediction model showed good discriminatory power (AUC = 0.86) and goodness of fit (Hosmer-Lemeshow, P = 0.729). The internal validation demonstrated an AUC of 0.86 and a good calibration curve fit (Hosmer-Lemeshow, P = 0.914). Prospective clinical validation confirmed the reliability and clinical value of the model (AUC = 0.91, accuracy = 82.35%).
Conclusion:
The nomogram prediction model based on independent risk factors for postoperative ARDS in patients with digestive tumors demonstrated good differentiation, calibration, and clinical utility and helped identify high-risk patients early.
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