肠造口患者术后早期造口旁疝临床预测模型构建及验证

Construction and validation of a clinical prediction model for early postoperative parastomal hernia in patients with enterostomy

目的构建肠造口患者术后早期造口旁疝的临床预测模型,并进行内、外部验证和临床获益性评价。方法采用便利抽样法,选取2013年10月—2020年12月在复旦大学附属中山医院就诊的1071例肠造口患者为研究对象。将2013年10月—2019年12月的患者作为建模组(n=943),通过问卷调查等方式获取患者资料,基于Cox回归分析构建肠造口患者术后早期造口旁疝临床预测模型,并使用Bootstrap法对模型进行内部验证;将2020年1—12月的患者作为验证组(n=128),对模型进行外部验证。采用C-统计量、受试者工作特征曲线下面积及校准图评价模型的区分度和校准度。采用决策曲线分析法绘制决策曲线分析图,评价该预测模型的临床获益性。结果年龄、饮酒史、术后体重指数、糖尿病、呼吸系统疾病、腹部手术史、造口途径、造口性质和C反应蛋白是肠造口患者术后早期发生造口旁疝的独立影响因素(P<0.05),术后早期预测列线图的C-index值为0.710(95%置信区间:0.660~0.750)。结论肠造口患者术后早期造口旁疝的临床预测模型具有较好的预测效能,能帮助临床医护人员及时筛选出高危人群,指导医护人员的预防重点。

Objective To construct a clinical prediction model for early postoperative parastomal hernia in patients with enterostomy and to conduct internal and external validation and evaluation of clinical benefit.Methods A total of 1071 patients with enterostomy treated in Zhongshan Hospital Affiliated to Fudan University from October 2013 to December 2020 were selected as the research objects by the convenient sampling method.Patients from October 2013 to December 2019 were selected as the modeling group(n=943).The data of patients were obtained by questionnaire and other methods.The clinical prediction model of early postoperative parastomal hernia in patients with enterostomy was constructed based on Cox regression analysis and the model was internally verified by Bootstrap method.Patients from January to December 2020 were selected as the validation group(n=128)for external validation of the model.C-statistic,area under receiver operating characteristic curve and calibration map were used to evaluate the discrimination and calibration of the model.Decision curve analysis was used to draw decision curve analysis chart to evaluate the clinical benefit of the prediction model.Results Age,history of alcohol consumption,postoperative body mass index,diabetes mellitus,respiratory diseases,history of abdominal surgery,stoma route,stoma nature and C-reactive protein were independent influencing factors for early postoperative parastomal hernia in patients with enterostomy(P<0.05).The C-index value of early postoperative nomogram was 0.710(95%CI:0.660-0.750).Conclusions The clinical prediction model of early parastomal hernia in patients with enterostomy has good predictive performance,which can help clinical medical staff to screen out high-risk groups in time and guide medical staff to focus on prevention.