Development And Validation Of A Risk Prediction Model For Postoperative ICU Admission Of Colorectal Cancer Patients

Objective For patients undergoing curative surgery for colorectal cancer,postoperative admission to the intensive care unit(ICU)is one of the most common complications after non-cardiac surgery.Research has found that postoperative ICU admission for critically ill patients can reduce the mortality rate.However,the most common complications of postoperative ICU admission are infections,particularly respiratory and surgical site infections.There is growing evidence that ICU hospitalization is expensive,consumes the hospital’s main resources,and is associated with the worst outcomes.So far,there is not enough evidence to determine which colorectal cancer surgery patients benefit the most from postoperative ICU admission.Therefore,this study aims to use a retrospective approach to identify risk factors for postoperative ICU admission in colorectal cancer surgery patients,and to construct a risk prediction model for postoperative ICU admission to guide decision-making in the care of these patients.Methods We conducted a retrospective analysis of 1003 patients with colorectal cancer who underwent curative or palliative surgery at the General Hospital of Ningxia Medical University from August 2020 to April 2022.Patients were randomly assigned to a training cohort(70%)and a validation cohort(30%).Using the least absolute shrinkage and selection operator(LASSO)and multivariate logistic regression,we identified independent predictive factors in the training cohort to construct a nomogram,which was then used to create an online prediction tool for clinical application.The calibration and discrimination of the nomogram were evaluated in the training cohort and validated in the validation cohort.Finally,the clinical value of the nomogram was evaluated using decision curve analysis(DCA).Results The final prediction model includes the following predictors: Age(OR=3.623,95%CI: 1.535-8.551;P = 0.003),NRS2002(OR=6.129,95%CI: 2.920-12.863;P=0.000),ALB(OR=0.921,95%CI: 0.863-0.982;P=0.013),atrial fibrillation(OR=20.017,95%CI:4.191-95.609;P=0.000),COPD(OR=8.151,95%CI: 1.674-39.676;P=0.009),FEV1/FVC OR=0.966,95%CI: 0.935-0.998;P=0.040)and type of surgery(OR=0.425,95%CI:0.202-0.891;P=0.024).A nomogram was constructed using these seven factors,and the area under the curve and concordance index were 0.865 and 0.873,respectively.The Hosmer-Lemeshow test indicated good model fit(P=0.367),and the calibration curve of the nomogram was close to the ideal diagonal line.Furthermore,in the clinical decision curve analysis,the net benefit of the postoperative ICU admission risk prediction model was significantly better.For convenience,a postoperative admission to the ICU risk prediction column line chart was constructed and built for an online web server:https://picuadmission.shinyapps.io/Dnamic Nomogram/.Conclusion Age,preoperative serum albumin level,nutritional risk screening,atrial fibrillation,chronic obstructive pulmonary disease,one-second rate,and surgical pathway were predictors of postoperative ICU admission in patients undergoing radical colorectal cancer surgery.Postoperative ICU admission risk prediction line chart,online web server and risk stratification facilitate clinical decision making on the need for postoperative ICU admission for patients undergoing radical colorectal cancer surgery.