Ziwei Dong, Xiaoli Yin, Doudou Xu, Jiaying Zhao, Yang Wang
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引用次数: 0
Abstract
Background: Necrotizing enterocolitis (NEC) is a severe inflammatory intestinal disease in preterm infants, marked by heightened morbidity and mortality. Timely prediction of NEC is significant in the management of critical neonates. However, it is difficult to predict NEC accurately because of the multi-factorial pathogenesis. This study aimed to develop a prediction model through repeated measurement data to further improve the accuracy of prediction in NEC.
Methods: We retrospectively collected clinical data of premature infants admitted to the Neonatology Department of the First Affiliated Hospital of Anhui Medical University from January 2016 to December 2023. The infants were categorized into the NEC group (Bell's stage ≥ II) (n=150) and the non-NEC group (n=150). The clinical baseline data of the NEC and non-NEC groups were matched. Laboratory examination indicators were collected on the 1st day, the 7th day after birth, and the day of NEC onset. Univariate and multivariate logistic regression analyses were conducted to identify independent factors influencing NEC. A nomogram was constructed based on these factors to predict NEC. The concordance index and calibration plot were used to assess the efficiency of the nomogram in the training and validation cohorts.
Results: This study demonstrated that antenatal steroids, antenatal antibiotics, probiotics treatment before NEC, anion gap (AG, day 7), and mean corpuscular volume (MCV, day 7) were independent risk factors which combined to accurately predict NEC. A nomogram of NEC was created utilizing these five predictors. With an area under the receiver operator characteristic (ROC) curve of 0.835 [95% confidence interval (CI): 0.785-0.884]. Concordance index for the training and validation groups were 0.835 and 0.848, respectively. As the calibration plots indicate, the predicted probability of NEC is highly consistent with the actual observation.
Conclusions: The risk estimation nomogram for NEC offers clinical value by guiding early prediction, targeted prevention, and early intervention strategies for NEC.
背景:坏死性小肠结肠炎(NEC坏死性小肠结肠炎(NEC)是早产儿的一种严重肠道炎症性疾病,发病率和死亡率都很高。及时预测 NEC 对危重新生儿的治疗意义重大。然而,由于 NEC 的发病机制是多因素的,因此很难准确预测。本研究旨在通过重复测量数据建立预测模型,以进一步提高 NEC 预测的准确性:我们回顾性收集了2016年1月至2023年12月期间安徽医科大学第一附属医院新生儿科收治的早产儿的临床数据。这些婴儿被分为NEC组(Bell's分期≥II)(n=150)和非NEC组(n=150)。NEC组和非NEC组的临床基线数据相匹配。实验室检查指标收集于出生后第1天、第7天和NEC发病当天。进行了单变量和多变量逻辑回归分析,以确定影响 NEC 的独立因素。根据这些因素构建了预测 NEC 的提名图。使用一致性指数和校准图评估训练队列和验证队列中提名图的效率:结果:该研究表明,产前类固醇、产前抗生素、NEC发生前的益生菌治疗、阴离子间隙(AG,第7天)和平均血球容积(MCV,第7天)是独立的风险因素,这些因素结合在一起可准确预测NEC。利用这五个预测因子绘制了 NEC 的提名图。接受者操作特征(ROC)曲线下面积为 0.835 [95%置信区间(CI):0.785-0.884]。训练组和验证组的一致性指数分别为 0.835 和 0.848。正如校准图所示,NEC 的预测概率与实际观察结果高度一致:NEC的风险估计提名图可指导NEC的早期预测、针对性预防和早期干预策略,具有临床价值。