The development of nomogram of the occurrence of parenteral nutrition-associated cholestasis in neonates
张慧 1彭晓春 2刘念 2汪家安1
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作者信息
1. 安徽省妇幼保健院西区新生儿科,合肥 230001
2. 安徽医科大学第一附属医院重症医学科,合肥 230022
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摘要
目的 本研究的目的是分析新生儿肠外营养相关性胆汁淤积症(Parenteral Nutrition Assosiated Cholestasis,PNAC)的临床特点,建立一个可视化预测模型来评估PNAC发生风险.方法 选取安徽省妇幼保健院新生儿重症监护病房(Neonatal Intensive Care Unit,NICU)2020年01月至2023年11月收治的肠外营养≥14天的新生儿294例,诊断为新生儿肠外营养相关性胆汁淤积症者64例.通过单因素和Logistic多因素分析出影响肠外营养相关性胆汁淤积症新生儿发生风险的因素,建立预测模型列线图(Nomogram),并通过bootstrap进行内部验证.结果 Logistic多因素分析计算得计算得出出生体重OR 0.749(95％CI0.575～0.976),P=0.032,Apgar 评分 OR 21.939(95％CI 3.558～135.283),P=0.001 和禁食时间 OR 6.975(95％CI 1.014～47.984),P=0.048.出生体重、出生时Apgar评分和禁食时间是影响新生儿肠外营养相关性胆汁淤积症发生的因素是影响新生儿肠外营养相关性胆汁淤积症发生的独立危险因素.内部验证经bootstrap验证,具有较好的判别程度.校准曲线表明,模型具有较好的一致性.由出生体重、出生时Apgar评分和禁食时间是合成为一个综合模型进行ROC分析,模型AUC 0.882,可见模型在预测新生儿PNAC发生率方面显示出较好的辨别力.结论 基于出生体重、出生时Apgar评分和禁食时间构建的nomogram预测模型可有效筛选出发生新生儿肠外营养相关性胆汁淤积症的因素,为新生儿肠外营养相关性胆汁淤积症的个体化治疗提供依据.
Abstract
Objective The aims of this study were to analyze the clinical features of parenteral nutrition assosiated cholestasis(PNAC)in neonates and to develop a visual predictive model to assess the risk of developing PNAC.Methods A total of 294 neo-nates with parenteral nutrition ≥ 14 days admitted to the Neonatal Intensive Care Unit(NICU)of Anhui Maternal and Child Health Hospital from January 2020 to October 2023 were selected,and 64 cases were diagnosed with neonatal parenteral nutrition-associated cholestasis.Factors affecting the risk of neonatal development of parenteral nutrition-associated cholestasis were analyzed by univariate and logistic multifactorial analysis,and a predictive model was established and internally validated by bootstrap.Results Logistic mul-tivariate analysis calculated calculated birth weight OR 0.749(95％CI 0.575～0.976),P=0.032,Apgar score OR 21.939(95％CI 3.558～135.283),P=0.001 and fasting time OR 6.975(95％CI 1.014～47.984),P=0.048.birthweight,Apgar score at birth and duration of fasting were the factors affecting the development of parenteral nutrition-associated cholestasis in neonates were the independent risk factors affecting the development of parenteral nutrition-associated cholestasis in neonates.Internal validation was vali-dated by bootstrap with a good degree of discrimination.Calibration curves showed that the model had good agreement.Consisting of birth weight,Apgar score at birth and duration of fasting were synthesized into a composite model for ROC analysis,with a model AUC of 0.882,which shows that the model shows good discrimination in predicting the incidence of PNAC in neonates.Conclusion A no-mogram prediction model based on prematurity,birth weight,and duration of parenteral nutrition can effectively screen out the factors for the occurrence of neonatal parenteral nutrition-associated cholestasis,and provide a basis for individualized treatment of neonatal parenteral nutrition-associated cholestasis.
关键词
新生儿/肠外营养相关性胆汁淤积症/发生风险/列线图
Key words
neonate/parenteral nutrition-associated cholestasis/risk of occurrence/nomogram
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