Age and mean platelet volume-based nomogram for predicting the therapeutic efficacy of metoprolol in Chinese pediatric patients with vasovagal syncope

IF 6.1 2区医学 Q1 PEDIATRICS World Journal of Pediatrics Pub Date : 2024-04-13 DOI:10.1007/s12519-024-00802-5

Xiao-Juan Du, Ya-Qian Huang, Xue-Ying Li, Ying Liao, Hong-Fang Jin, Jun-Bao Du

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Abstract

Background

Vasovagal syncope (VVS) is the most common type of orthostatic intolerance in children. We investigated whether platelet-related factors related to treatment efficacy in children suffering from VVS treated with metoprolol.

Methods

Metoprolol-treated VVS patients were recruited. The median duration of therapy was three months. Patients were followed and divided into two groups, treament-effective group and treatment-ineffective group. Logistic and least absolute shrinkage selection operator regressions were used to examine treatment outcome variables. Receiver-operating characteristic (ROC) curves, precision–recall (PR) curves, calibration plots, and decision curve analyses were used to evaluate the nomogram model.

Results

Among the 72 patients who complete the follow-up, treatment-effective group and treatment-ineffective group included 42 (58.3%) and 30 (41.7%) cases, respectively. The patients in the treatment-effective group exhibited higher mean platelet volume (MPV) [(11.0 ± 1.0) fl vs. (9.8 ± 1.0) fl, P < 0.01] and platelet distribution width [12.7% (12.3%, 14.3%) vs. 11.3% (10.2%, 12.2%), P < 0.01] than those in the treatment-ineffective group. The sex ratio was significantly different (P = 0.046). A fit model comprising age [odds ratio (OR) = 0.766, 95% confidence interval (CI) = 0.594–0.987] and MPV (OR = 5.613, 95% CI = 2.297–13.711) might predict therapeutic efficacy. The area under the curve of the ROC and PR curves was computed to be 0.85 and 0.9, respectively. The P value of the Hosmer–Lemeshow test was 0.27. The decision curve analysis confirmed that managing children with VVS based on the predictive model led to a net advantage ranging from 0.01 to 0.58. The nomogram is convenient for clinical applications.

Conclusion

A novel nomogram based on age and MPV can predict the therapeutic benefits of metoprolol in children with VVS.

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基于年龄和平均血小板体积的预测美托洛尔对中国儿童血管迷走性晕厥患者疗效的提名图

背景血管迷走性晕厥（VVS）是儿童中最常见的直立性不耐受类型。我们研究了血小板相关因素是否与美托洛尔治疗 VVS 儿童的疗效有关。中位治疗时间为三个月。对患者进行随访，并将其分为两组，即治疗有效组和治疗无效组。采用逻辑回归和最小绝对缩小选择运算回归来检验治疗结果变量。结果在完成随访的 72 例患者中，治疗有效组和治疗无效组分别有 42 例（58.3%）和 30 例（41.7%）。治疗有效组患者的平均血小板体积（MPV）[（11.0 ± 1.0）fl vs. （9.8 ± 1.0）fl，P < 0.01]和血小板分布宽度[12.7% (12.3%, 14.3%) vs. 11.3% (10.2%, 12.2%)，P < 0.01]均高于治疗无效组患者。性别比例有明显差异（P = 0.046）。由年龄[几率比（OR）= 0.766，95% 置信区间（CI）= 0.594-0.987]和 MPV（OR = 5.613，95% CI = 2.297-13.711）组成的拟合模型可预测疗效。经计算，ROC 曲线和 PR 曲线的曲线下面积分别为 0.85 和 0.9。Hosmer-Lemeshow 检验的 P 值为 0.27。决策曲线分析证实，根据预测模型管理 VVS 患儿可获得 0.01 至 0.58 的净优势。结论基于年龄和 MPV 的新型提名图可以预测美托洛尔对 VVS 儿童的治疗效果。

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来源期刊

World Journal of Pediatrics 医学-小儿科

CiteScore

10.50

自引率

1.10%

发文量

592

审稿时长

2.5 months

期刊介绍： The World Journal of Pediatrics, a monthly publication, is dedicated to disseminating peer-reviewed original papers, reviews, and special reports focusing on clinical practice and research in pediatrics. We welcome contributions from pediatricians worldwide on new developments across all areas of pediatrics, including pediatric surgery, preventive healthcare, pharmacology, stomatology, and biomedicine. The journal also covers basic sciences and experimental work, serving as a comprehensive academic platform for the international exchange of medical findings.