Analysis Of Risk Factors For Intra-abdominal Infection Within Thirty Days After Liver Transplantation And The Establishment Of A Novel Nomogram

Objective:Existing studies suggest that multiple independent risk factors can be diagnosed and intervened early to reduce the incidence of early intra-abdominal infections after liver transplantation.However,the risk factors associated with the development of intra-abdominal infections after liver transplantation have not been well studied.The existing studies are inadequate in terms of sample size and analysis of independent risk factors,and there is a lack of standard models to effectively predict the development of abdominal cavity infection after liver transplantation.There is an urgent need for studies with large sample sizes and comprehensive analyses of independent risk factors,and for the development of a new nomogram to predict the likelihood of abdominal cavity infection in the early post-transplant period.Methods:The study systematically retrospectively analysed the clinical data of a total of 331 post-liver transplant patients in our centre between July 2018 and February 2022.Data were processed using SPSS 25.0 and R version 4.1.3 with "survival","lattice ","formula","ggplot2","hmisc","rms ","survvival","readxl","plyr"," survminer" packages for statistical analysis and image plotting.Results:We included the suspected risk factors in the univariate COX regression,excluding intermediate variables,in the multifactorial COX regression analysis and finally obtained three independent risk factors: MELD score,CHILD score,artificial liver,history of abdominal surgery,duration of surgery,duration of liver-free period,biliary-intestinal anastomosis,length of ICU stay,duration of abdominal drainage tube retention,renal replacement therapy,plasma replacement,secondary surgery and postoperative abdominal bleeding.Three independent risk factors were identified: MELD score greater than or equal to 20(HR:2.52,95% CI: 1.18-5.37,P=0.017<0.05);history of abdominal surgery(HR:2.26,95% CI: 1.14-4.51,P=0.020<0.05);secondary surgery(HR: 4.68,95%CI: 0.35-3.12,P=0.05);and length of stay in the hospital.3.12,P=0.003<0.05).The Kaplan-Meier method with Log-Rank test was used to compare betweengroup differences in three independent influences on the occurrence of abdominal infection within thirty days after liver transplantation in this study.Based on the multi-factor COX regression,we systematically integrated the three independent risk factors for intra-abdominal infection within 30 days after liver transplantation to produce a Nomogram and obtained a consistency index(Cindex)of 0.747,indicating that this Nomogram has a high predictive value.The calibration curve of the Nomogram was also plotted,and the predictive power of the Nomogram was found to be good.The ROC curve was also plotted,and the AUC of this nomogram was 0.774,making it highly accurate for determining the occurrence of intra-abdominal infection after liver transplantation.Conclusion:1.This study identified three independent risk factors for abdominal infection within 30 days after liver transplantation: MELD score greater than or equal to 20,history of abdominal surgery and second postoperative surgery.2.Based on the independent risk factors,a new nomogram was developed and validated by calibrating the positive curve and the AUC curve,which has a good predictive value.