Ultrasound-based nomogram for predicting high-risk hepatic portal venous gas in children: a retrospective cohort...

Hepatic portal venous gas (HPVG) is an uncommon but potentially life-threatening ultrasonographic finding in the pediatric population. Early identification of high-risk HPVG cases requiring urgent surgical intervention remains a clinical challenge. This study aimed to develop and validate an ultrasound-based nomogram for predicting high-risk HPVG in children.

A retrospective cohort of 107 pediatric patients with ultrasound-confirmed HPVG was analyzed. Participants were divided into high-risk group (n=20) and benign group (n=87) based on whether they underwent abdominal surgery or died. Clinical characteristics and ultrasound features were compared between groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. A nomogram was subsequently constructed, with model performance assessed via receiver operating characteristic (ROC) curves, calibration curves, the Hosmer-Lemeshow goodness-of-fit test, bootstrap internal validation, and decision curve analysis (DCA).

Multivariate logistic regression identified bowel wall layer [unclear vs. clear: odds ratio (OR) =25.171, 95% confidence interval (CI): 4.249-227.708, P=0.001] and intestinal gas distribution (localized vs. none: OR =6.978, 95% CI: 1.515-51.211, P=0.02; diffuse vs. none: OR =65.077, 95% CI: 10.107-663.804, P<0.001) as independent predictors of high-risk HPVG. The model demonstrated good discriminative capability [area under curve (AUC) =0.899, 95% CI: 0.843-0.956]. The Hosmer-Lemeshow test confirmed adequate model fit (P=0.051). Bootstrap internal validation with 500 resamples yielded an optimism-corrected AUC of 0.879 (95% CI: 0.755-0.965), with minimal optimism of 0.020. DCA confirmed meaningful clinical net benefit across a wide range of threshold probabilities.

This study developed and validated an ultrasound-based prediction model for identifying high-risk HPVG in children. Loss of bowel wall stratification and abnormal intestinal gas distribution were identified as independent predictors of adverse outcomes. This model provides a practical, point-of-care risk stratification tool that can assist physicians in distinguishing children with HPVG who may benefit from urgent surgical intervention from those who can be managed conservatively.