Construction of a nomogram model for predicting the risk of pancreatic fistula after pancreaticoduodenectomy with PCT,albumin and bilirubin levels
Objective To investigate a column-line graphical model of procalcitonin (PCT),albu-min and bilirubin levels to predict the risk of postoperative pancreatic fistula (POPF) following pancreaticoduo-denectomy (PD).Methods A total of 120 patients with PD who underwent pancreatic surgery at Mianyang Central Hospital from January 2020 to January 2023 were retrospectively selected.7 cases were excluded,leav-ing a total of 113 cases included in the study.According to a 3∶1 ratio,35 cases developed POPF based on the diagnostic criteria proposed by ISGPF in 2016.Of these,26 cases were from the modeling group and 9 cases from the validation group.We analyzed the single factors contributing to POPF after PD in the modeling group.We included variables with P<0.05 in the binary logistic regression analysis and screened them using the Back-wald method.Based on this analysis,we constructed a prediction model for the risk of postoperative POPF after PD in a column-line diagram.The AUC was used to evaluate the discrimination of the column-line graph model,the calibration curve to assess the relationship between the model's predicted odds and the actual probability,and the Hosmer-Lemeshow goodness-of-fit test to evaluate the fit of the column-line graph model.Results Comparison of the levels of pancreatic duct diameter,pancreatic texture,FRS score,total abdominal fat,ab-dominal wall fat,preoperative bilirubin,preoperative albumin,and preoperative PCT between those who devel-oped POPF and those who did not in the modeling group showed statistically significant differences (P<0.05).The results of multifactorial logistic regression analysis showed that pancreatic duct diameter ≥ 0.25 cm,pancre-atic texture as hard,FRS score ≥ 5,total abdominal fat ≥ 240 cm,abdominal wall fat ≥ 98 cm,preoperative bilirubin and preoperative increase in PCT level were the risk factors affecting the occurrence of postoperative POPF in PD,and the preoperative decrease in albumin level was the protective factor affecting the occurrence of POPF (P<0.05).Each factor corresponded to a corresponding score,and an increase in the risk factor score in-creased the risk of POPF after PD surgery;if the protective factor score increased,the risk of POPF after PD surgery decreased.Model validation:the AUC curve in the ROC of the modeling group was 0.889,with a 95％CI of 0.740-0.966;the calibration curve of the model in the modeling group and the validation group was close to the standard curve;Hosmer-Lemeshow goodness-of-fit test,P=0.793,0.688.Conclusion PCT,albumin and bilirubin levels play an important predictive role in the risk of POPF after PD.By monitoring changes in these in-dicators preoperatively,potential risk factors for POPF can be detected in time.This allows for appropriate pre-ventive and therapeutic measures to be taken to reduce the incidence of POPF.
万方数据
维普
