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Prediction model for risk of multiple organ dysfunction syndrome in wasp sting patients: development and validation
Hongmei Dai1, Dongmei Liu1, Li Yang1
1Department of Nephrology and Hematology, Yunyang County People's Hospital, Yunyang County, Chongqing, China.
Objective:
Multiple organ dysfunction syndrome (MODS) is a life-threatening complication of wasp stings. This study aimed to identify factors associated with MODS and develop a quantitative risk prediction model.
Methods:
A retrospective cohort study included 324 wasp sting patients (January 2018-December 2023), divided into MODS (n = 90) and non-MODS (n = 234) groups. General characteristics, imaging findings, and laboratory parameters were compared. Composite indicators with clinical interpretability were incorporated into binary logistic regression to identify risk factors. A nomogram-based prediction model was established and evaluated using ROC curves, calibration curves, and decision curves.
Results:
Significant differences were observed between groups in age, time from sting to admission, pleural effusion, RALE score, PLT, LYM, MO, FIB, ALB, MPV/PLT, P-LCR, FAR, FPR, CLR, SHR, NLR, PLR, PNR, SIRI, and SII (all P < 0.05). After excluding collinear variables (VIF > 5), binary logistic regression identified age, time to admission, pleural effusion, RALE score, MPV/PLT, and SIRI as independent risk factors (OR > 1, all P < 0.05). A nomogram prediction model was developed. ROC analysis showed an AUC of 0.828 (95% CI: 0.776-0.880). At the optimal cutoff of 0.368, sensitivity was 66.7%, specificity 87.9%, PPV 68.9%, and NPV 86.8%. Calibration curves showed good agreement, and decision curves demonstrated high net clinical benefit.
Conclusion:
MODS occurrence after wasp stings may be associated with RALE score, MPV/PLT, and SIRI levels, while the roles of age, time to admission, and pleural effusion require further validation. The nomogram model provides a useful reference for clinical MODS risk assessment but lacks external validation, requiring confirmation in future large-scale, multicenter, prospective studies.
Insights
Multiple organ dysfunction syndrome (MODS) from wasp stings is linked to RALE score, MPV/PLT, and SIRI. A new nomogram model aids in assessing MODS risk, though further validation is needed.
Area of Science:
- Emergency Medicine
- Toxicology
- Clinical Prediction Modeling
Background:
- Multiple organ dysfunction syndrome (MODS) is a severe complication following wasp stings.
- Identifying predictive factors for MODS is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To identify clinical and laboratory factors associated with MODS after wasp stings.
- To develop and validate a quantitative risk prediction model for MODS in wasp sting patients.
Main Methods:
- A retrospective cohort study of 324 wasp sting patients was conducted.
- Binary logistic regression and nomogram construction were used to identify risk factors and build a prediction model.
- Model performance was evaluated using ROC curves, calibration curves, and decision curves.
Main Results:
- Independent risk factors for MODS included age, time to admission, pleural effusion, RALE score, MPV/PLT ratio, and SIRI.
- The developed nomogram achieved an AUC of 0.828, indicating good predictive accuracy.
- The model demonstrated good calibration and clinical utility.
Conclusions:
- RALE score, MPV/PLT, and SIRI are potential indicators for MODS following wasp stings.
- The nomogram model serves as a valuable tool for clinical risk assessment of MODS.
- External validation in prospective studies is recommended to confirm the model's generalizability.