重症急性胰腺炎患者肠内营养喂养不耐受风险的列线图模型的建立

Establishment of a predictive nomogram model for enteral nutrition feeding intolerance in patients with severe acute pancreatitis

目的通过分析重症急性胰腺炎(severe acute pancreatitis,SAP)患者肠内营养喂养不耐受(enteral nutrition feeding intolerance,ENFI)发生的相关危险因素,建立个体化预测ENFI发生风险的列线图模型。方法采用目的抽样法回顾性收集2015年1月—2017年12月于山东大学附属省立医院诊治的SAP患者118例,收集临床资料,采用单因素及多因素Logistic回归模型分析ENFI发生的独立危险因素;应用R软件建立预测SAP患者ENFI发生风险的列线图模型,采用Bootstrap法进行模型验证,并应用ROC曲线探索列线图模型对ENFI发生风险的预测效率。结果 118例SAP患者中有49例发生ENFI,发生率为41.5%。Logistic回归分析显示,年龄≥70岁(OR=1.377,95%CI:1.088~1.743)、空腹血糖≥11.0 mmol/L(OR=3.222,95%CI:1.545~6.719)、肠内营养开始时间≥72 h(OR=3.800,95%CI:1.541~9.370)、未添加膳食纤维(OR=7.419,95%CI:2.651~20.760)及腹内压≥15 mmHg(OR=3.881,95%CI:1.735~8.679)均是SAP患者ENFI发生的独立危险因素(P<0.05)。列线图模型预测SAP患者ENFI发生风险的一致性指数为0.869;ROC曲线显示列线图模型预测ENFI发生风险的曲线下面积为0.857(95%CI:0.779~0.931)。结论 SAP患者ENFI发生的独立危险因素有年龄≥ 70岁、空腹血糖≥ 11.0 mmol/L、肠内营养开始时间≥72 h、未添加膳食纤维及腹内压≥ 15 mmHg。本研究建立的预测SAP患者ENFI发生风险的列线图模型具有良好的区分度与精准度,可指导个体化预测ENFI发生风险。

Objective To establish a individualized predictive nomogram model for enteral nutrition feeding intolerance (ENFI) by analyzing the risk factors of ENFI in patients with severe acute pancreatitis (SAP). Methods The clinical data of 188 SAP patients hospitalized in Shandong Provincial Hospital Affiliated to Shandong University from January 2015 to December 2017 were retrospectively collected by objective sampling. Univariate and multivariate Logistic regression analysis were used to identify the independent risk factors of ENFI. R software was used to establish a predictive nomogram model. Bootstrap method was used to validate the nomogram model and ROC curve was used to explore the predictive efficacy of the model in predicting the ENFI. Results A total of 49 cases out of 118 SAP patients developed ENFI, with an incidence of 41.5%. The result of Logistic regression analysis showed that the independent risk factors of ENFI in SAP patients were age≥70 years old (OR=1.377, 95%CI: 1.088-1.743), fasting blood glucose≥11.0 mmol/L (OR=3.222, 95%CI: 1.545-6.719), enteral nutrition starting time≥72 h (OR=3.800, 95%CI: 1.541-9.370), no dietary fiber added (OR=7.419, 95%CI: 2.651-20.760) and intra-abdominal pressure≥15 mmHg (OR=3.881, 95%CI: 1.735-8.679)(P<0.05). The nomogram model showed that the consistency index for predicting the risk of ENFI in SAP patients was 0.869, while ROC curve showed that the area under the curve for the nomogram model predicting ENFI was 0.857 (95%CI: 0.779-0.931). Conclusions The independent risk factors of ENFI in SAP patients are age≥70 years old, fasting blood glucose≥11.0 mmol/L, enteral nutrition starting time≥72 h, no dietary fiber added and intra-abdominal pressure ≥15 mmHg. The nomogram established in this study can predict the risk of ENFI in SAP patients with good discrimination and accuracy, which could be used for predicting individual ENFI in SAP patients.