Abstract：
BACKGROUND: The decision to perform a stoma during surgical resection of penetrating Crohn\'s disease (CD) is a critical consideration. The objective of this study was to identify factors that influence stoma creation and develop a predictive nomogram model to assist surgeons in making optimal surgical decisions.
METHODS: A retrospective study was conducted at a tertiary center from December 1, 2012, to December 1, 2021, involving consecutive patients with penetrating CD who underwent elective surgical resection. The LASSO regression method was used to select preoperative predictors, and a nomogram was constructed using multivariate logistic regression. The performance of the nomogram was validated in an internal cohort by assessing its discrimination, calibration, and clinical usefulness.
RESULTS: The study included 405 cases in the training group and 135 cases in the validation group. Nine risk factors for stoma formation were identified, including disease location, fistula resulted from previous anastomosis, absence of preoperative exclusive enteral nutrition support, albumin levels below 35 g/L, C-reactive protein levels above 10 mg/L, hemoglobin levels below 100 g/L, perianal disease, internal fistula, and surgical approach. These risk factors were selected using the LASSO regression method, and a nomogram was developed based on them. The area under the curve and the coefficient of determination (R2) of the nomogram were 0.821 and 0.394, respectively. And the nomogram demonstrated good performance in the validation cohort.
CONCLUSIONS: The nomogram exhibited good predictive ability for stoma formation during elective surgical resection for penetrating CD, which can assist surgeons in making informed clinical decisions.
METHODS: A retrospective study was conducted at a tertiary center from December 1, 2012, to December 1, 2021, involving consecutive patients with penetrating CD who underwent elective surgical resection. The LASSO regression method was used to select preoperative predictors, and a nomogram was constructed using multivariate logistic regression. The performance of the nomogram was validated in an internal cohort by assessing its discrimination, calibration, and clinical usefulness.
RESULTS: The study included 405 cases in the training group and 135 cases in the validation group. Nine risk factors for stoma formation were identified, including disease location, fistula resulted from previous anastomosis, absence of preoperative exclusive enteral nutrition support, albumin levels below 35 g/L, C-reactive protein levels above 10 mg/L, hemoglobin levels below 100 g/L, perianal disease, internal fistula, and surgical approach. These risk factors were selected using the LASSO regression method, and a nomogram was developed based on them. The area under the curve and the coefficient of determination (R2) of the nomogram were 0.821 and 0.394, respectively. And the nomogram demonstrated good performance in the validation cohort.
CONCLUSIONS: The nomogram exhibited good predictive ability for stoma formation during elective surgical resection for penetrating CD, which can assist surgeons in making informed clinical decisions.
摘要：
背景：决定在穿透性克罗恩病（CD）的手术切除期间进行造口是一个关键的考虑因素。这项研究的目的是确定影响造口创建的因素，并开发预测性列线图模型，以帮助外科医生做出最佳的手术决策。
方法：一项回顾性研究于2012年12月1日至2021年12月1日在一个三级中心进行，包括连续接受选择性手术切除的穿透性CD患者。采用LASSO回归方法选择术前预测因子,并使用多变量逻辑回归构建列线图。通过评估其区分度，在内部队列中验证了列线图的表现，校准,和临床有用性。
结果：本研究训练组405例，验证组135例。确定了9个造口形成的危险因素，包括疾病位置，由先前的吻合导致的瘘，没有术前专有的肠内营养支持，白蛋白水平低于35g/L，C反应蛋白水平高于10mg/L,血红蛋白水平低于100g/L，肛周疾病,内瘘,和手术方法。这些危险因素是使用LASSO回归方法选择的，并在此基础上开发了列线图。列线图的曲线下面积和决定系数(R2)分别为0.821和0.394。列线图在验证队列中表现良好。
结论：列线图对穿透性CD的选择性手术切除过程中造口形成具有良好的预测能力，这可以帮助外科医生做出明智的临床决定。
方法：一项回顾性研究于2012年12月1日至2021年12月1日在一个三级中心进行，包括连续接受选择性手术切除的穿透性CD患者。采用LASSO回归方法选择术前预测因子,并使用多变量逻辑回归构建列线图。通过评估其区分度，在内部队列中验证了列线图的表现，校准,和临床有用性。
结果：本研究训练组405例，验证组135例。确定了9个造口形成的危险因素，包括疾病位置，由先前的吻合导致的瘘，没有术前专有的肠内营养支持，白蛋白水平低于35g/L，C反应蛋白水平高于10mg/L,血红蛋白水平低于100g/L，肛周疾病,内瘘,和手术方法。这些危险因素是使用LASSO回归方法选择的，并在此基础上开发了列线图。列线图的曲线下面积和决定系数(R2)分别为0.821和0.394。列线图在验证队列中表现良好。
结论：列线图对穿透性CD的选择性手术切除过程中造口形成具有良好的预测能力，这可以帮助外科医生做出明智的临床决定。
