{"title":"预测严重新生儿坏死性小肠结肠炎的门静脉气体和提名图的价值。","authors":"Yixian Chen, Yuhui Duan, Ba Wei, Yongjiang Jiang, Yadan Tan, Yijun Wei, Yuan Gan, Yujun Chen","doi":"10.1038/s41390-024-03605-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Whether portal venous gas (PVG) is a sign of severe neonatal necrotizing enterocolitis (NEC) and predicts poor prognosis remains uncertain.</p><p><strong>Methods: </strong>Patients from two centres were randomly assigned to a training set or a validation set. A nomogram model for predicting severe NEC was developed on the basis of the independent risk factors selected by least absolute shrinkage and selection operator (LASSO) regression analysis and multivariate logistic regression analysis. The model was evaluated based on the area under the curve (AUC), calibration curve, and decision curve analysis (DCA).</p><p><strong>Results: </strong>A total of 585 patients met the study criteria, and propensity score matching resulted in 141 matched pairs for further analysis. Patients with PVG had a greater risk of surgical intervention or death compared with patients without PVG. A prediction model for severe NEC was established based on PVG, invasive mechanical ventilation (IMV), serum platelet count (PLT) and pH <7.35 at the onset of NEC. The model had a moderate predictive value with an AUC > 0.8. The calibration curve and DCA suggested that the nomogram model had good performance for clinical application.</p><p><strong>Conclusion: </strong>A prediction nomogram model based on PVG and other risk factors can help physicians identify severe NEC early and develop reasonable treatment plans.</p><p><strong>Impact: </strong>PVG is an important and common imaging manifestation of NEC. Controversy exists regarding whether PVG is an indication for surgical intervention and predicts poor prognosis. Our study suggested that patients with PVG had a greater risk of surgical intervention or death compared with patients without PVG. PVG, IMV, PLT and pH <7.35 at the onset of NEC are independent risk factors for severe NEC. A prediction nomogram model based on PVG and other risk factors may help physicians identify severe NEC early and develop reasonable treatment plans.</p>","PeriodicalId":19829,"journal":{"name":"Pediatric Research","volume":null,"pages":null},"PeriodicalIF":3.1000,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Value of portal venous gas and a nomogram for predicting severe neonatal necrotizing enterocolitis.\",\"authors\":\"Yixian Chen, Yuhui Duan, Ba Wei, Yongjiang Jiang, Yadan Tan, Yijun Wei, Yuan Gan, Yujun Chen\",\"doi\":\"10.1038/s41390-024-03605-6\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Whether portal venous gas (PVG) is a sign of severe neonatal necrotizing enterocolitis (NEC) and predicts poor prognosis remains uncertain.</p><p><strong>Methods: </strong>Patients from two centres were randomly assigned to a training set or a validation set. A nomogram model for predicting severe NEC was developed on the basis of the independent risk factors selected by least absolute shrinkage and selection operator (LASSO) regression analysis and multivariate logistic regression analysis. The model was evaluated based on the area under the curve (AUC), calibration curve, and decision curve analysis (DCA).</p><p><strong>Results: </strong>A total of 585 patients met the study criteria, and propensity score matching resulted in 141 matched pairs for further analysis. Patients with PVG had a greater risk of surgical intervention or death compared with patients without PVG. A prediction model for severe NEC was established based on PVG, invasive mechanical ventilation (IMV), serum platelet count (PLT) and pH <7.35 at the onset of NEC. The model had a moderate predictive value with an AUC > 0.8. The calibration curve and DCA suggested that the nomogram model had good performance for clinical application.</p><p><strong>Conclusion: </strong>A prediction nomogram model based on PVG and other risk factors can help physicians identify severe NEC early and develop reasonable treatment plans.</p><p><strong>Impact: </strong>PVG is an important and common imaging manifestation of NEC. Controversy exists regarding whether PVG is an indication for surgical intervention and predicts poor prognosis. Our study suggested that patients with PVG had a greater risk of surgical intervention or death compared with patients without PVG. PVG, IMV, PLT and pH <7.35 at the onset of NEC are independent risk factors for severe NEC. A prediction nomogram model based on PVG and other risk factors may help physicians identify severe NEC early and develop reasonable treatment plans.</p>\",\"PeriodicalId\":19829,\"journal\":{\"name\":\"Pediatric Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2024-09-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1038/s41390-024-03605-6\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1038/s41390-024-03605-6","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
摘要
背景:门静脉积气(PVG)是否是严重新生儿坏死性小肠结肠炎(NEC)的征兆并能预测不良预后仍不确定:方法: 两个中心的患者被随机分配到训练集或验证集。方法:来自两个中心的患者被随机分配到训练集或验证集,根据最小绝对收缩和选择算子(LASSO)回归分析和多变量逻辑回归分析选出的独立风险因素,建立了预测重症 NEC 的提名图模型。根据曲线下面积(AUC)、校准曲线和决策曲线分析(DCA)对模型进行了评估:共有 585 名患者符合研究标准,经倾向评分匹配后,有 141 对匹配患者接受了进一步分析。与无 PVG 的患者相比,有 PVG 的患者接受手术治疗或死亡的风险更高。根据 PVG、有创机械通气(IMV)、血清血小板计数(PLT)和 pH 值 0.8,建立了严重 NEC 的预测模型。校准曲线和 DCA 表明该预测模型在临床应用中表现良好:结论:基于 PVG 和其他风险因素的预测提名图模型可帮助医生早期识别严重 NEC 并制定合理的治疗方案:影响:PVG 是 NEC 重要而常见的影像学表现。关于 PVG 是否是手术干预的指征并预示不良预后,目前还存在争议。我们的研究表明,与没有 PVG 的患者相比,有 PVG 的患者接受手术干预或死亡的风险更大。PVG、IMV、PLT 和 pH
Value of portal venous gas and a nomogram for predicting severe neonatal necrotizing enterocolitis.
Background: Whether portal venous gas (PVG) is a sign of severe neonatal necrotizing enterocolitis (NEC) and predicts poor prognosis remains uncertain.
Methods: Patients from two centres were randomly assigned to a training set or a validation set. A nomogram model for predicting severe NEC was developed on the basis of the independent risk factors selected by least absolute shrinkage and selection operator (LASSO) regression analysis and multivariate logistic regression analysis. The model was evaluated based on the area under the curve (AUC), calibration curve, and decision curve analysis (DCA).
Results: A total of 585 patients met the study criteria, and propensity score matching resulted in 141 matched pairs for further analysis. Patients with PVG had a greater risk of surgical intervention or death compared with patients without PVG. A prediction model for severe NEC was established based on PVG, invasive mechanical ventilation (IMV), serum platelet count (PLT) and pH <7.35 at the onset of NEC. The model had a moderate predictive value with an AUC > 0.8. The calibration curve and DCA suggested that the nomogram model had good performance for clinical application.
Conclusion: A prediction nomogram model based on PVG and other risk factors can help physicians identify severe NEC early and develop reasonable treatment plans.
Impact: PVG is an important and common imaging manifestation of NEC. Controversy exists regarding whether PVG is an indication for surgical intervention and predicts poor prognosis. Our study suggested that patients with PVG had a greater risk of surgical intervention or death compared with patients without PVG. PVG, IMV, PLT and pH <7.35 at the onset of NEC are independent risk factors for severe NEC. A prediction nomogram model based on PVG and other risk factors may help physicians identify severe NEC early and develop reasonable treatment plans.
期刊介绍:
Pediatric Research publishes original papers, invited reviews, and commentaries on the etiologies of children''s diseases and
disorders of development, extending from molecular biology to epidemiology. Use of model organisms and in vitro techniques
relevant to developmental biology and medicine are acceptable, as are translational human studies