| Purpose: The objective of the study was to establish and validate a nomogram predicting the risk of preterm infants with Necrotizing enterocolitis(NEC)requiring surgical intervention based on clinical parameters,laboratory tests and imaging characteristics,and to facilitate guidance of treatment and improved prognosis.Methods: Clinical data of 252 preterm infants with confirmed NEC admitted to our neonatal intensive care unit(NICU)from January 2014 to August 2022 were retrospectively collected,including general information,pre-morbidities,treatment and ancillary investigations,and perinatal information of mothers,including age,pregnancy induced hypertension(PIH),gestational diabetes mellitus(GDM),prenatal use of dexamethasone,premature rupture of membranes(PROM)and amniotic fluid,placenta,and umbilical cord conditions.The groups were divided into medical treatment group and surgical intervention group according to the different NEC treatment modalities.Categorical variables were described using frequencies and percentages,with normally distributed continuous variables expressed as mean ± standard deviation and nonnormally distributed continuous variables expressed as median and interquartile spacing.The chi-square test and Fisher’s exact test were used for the comparison of categorical variables between the two groups,and the independent t-test was used for the comparison of continuous variables between the two groups.A least absolute shrinkage and selection operator regression(Lasso regression)was used to optimize the selection of features for the surgical NEC risk model.Then,a predictive model was developed by incorporating the features selected in the Lasso regression model using logistic multivariate logistic regression analysis.Finally,the performance of the model was evaluated in three main ways: area under the curve(AUC),consistency index(Cindex)to verify discrimination,calibration curve to verify consistency,and decision curve analysis(DCA)to determine clinical validity.Results: Of the 252 preterm infants with confirmed NEC,180 were in the medical treatment group and 72 were in the surgical intervention group.There was no statistically significant difference in the incidence of maternal age,PIH,GDM,prenatal dexamethasone use,PROM,amniotic fluid fecal contamination,amniotic fluid volume,placenta,and umbilical cord abnormalities between the two groups.Gestational age(GA),birth weight(BW),hemoglobin(Hb),platelets(PLT),platelet distribution width(PDW),mean platelet volume(MPV),C-reactive protein(CRP),procalcitonin(PCT),albumin(ALB),Duke Abdominal Assessment Scale(DAAS)≥7 and seven clinical indicators of metabolic disorders(MD7)≥3 in the two groups were statistically different(all P ≤ 0.01).Risk characteristics were optimized by Lasso regression,and the results identified six risk characteristics,GA,Hb,MPV,ALB,DAAS ≥7 and MD7 ≥3.Multifactorial logistic regression analysis was used to find GA(OR=8.177,95%CI:0.680-9.749),Hb(OR=9.212,95% CI:0.883-9.569),MPV(OR=1.562,95%CI:1.066-2.350),ALB(OR=8.728,95% CI: 0.781-9.681),DAAS≥7(OR=9.101,95%CI:2.592-3.678)and MD7≥3(OR=3.251,95%CI: 1.009-1.041)were independent predictors of surgical NEC,and thus a prediction model for the risk of NEC surgery was constructed.Among them,there was good agreement between the ideal prediction in the calibration curve and the actual observation,with a corrected C-index of 0.885(95% CI: 0.836-0.934)and an AUC of 0.885.The DCA curve showed a more plausible net clinical benefit when the threshold of surgical intervention required reached 10%.Conclusion: This study suggests that GA,Hb,MPV,ALB,DAAS ≥7 and MD7 ≥3 are independent predictors of surgical NEC,and is used to construct and validate a nomogram of the risk of NEC surgery.This model can be used to identify preterm infants with NEC requiring surgical intervention by commonly used clinical tests,thus facilitating clinical decision making and improving the prognosis of the patients. |
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