小児肝移植患者における術後腹腔内高血圧を予測するためのノモグラム：前向き観察研究

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.