Un nomograma para predecir la hipertensión intraabdominal posoperatoria en pacientes pediátricos tras un trasplante...

To create a nomogram for early intra-abdominal hypertension (IAH) detection in pediatric patients following liver transplantation (LT).

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.

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).

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.