背景:ERCP后胰腺炎是ERCP相关手术中最常见的不良事件之一。本研究的目的是通过筛选相关临床参数,构建一个在线模型来预测非老年胆总管结石患者ERCP术后胰腺炎的风险。
方法:从中国某三甲医院7154例患者中选取919例。使用LASSO回归从28个潜在预测变量中选择的变量拟合多变量逻辑回归模型。通过评估受试者工作特征曲线和曲线下面积来评估内部和外部验证。使用受限的三次样条建模来探索非线性关联。为风险预测而开发的交互式Web应用程序是使用R“shiny”软件包构建的。
结果:ERCP术后胰腺炎的发生率为5.22%(48/919),女性非老年患者明显增高,高血压,胰腺炎的病史,困难的插管,内镜括约肌切开术,碱性磷酸酶较低,胆总管直径较小。测试和外部验证集中的预测性能为0.915(95%CI,0.858-0.972)和0.838(95%CI,0.689-0.986),分别。多元限制性三次样条结果显示,33-50岁时胰腺炎的发病率增加,中性粒细胞百分比>58.90%,血红蛋白>131g/L,血小板<203.04或>241.40×109/L,总胆红素>18.39umol/L,天冬氨酸氨基转移酶<36.56IU/L,碱性磷酸酶<124.92IU/L,白蛋白<42.21g/L,胆总管直径在7.25~10.02mm之间。此外,开发了支持即时PEP风险查询的Web服务器。
结论:上述模型的可视化网络版本能够最准确地预测非老年胆总管结石患者的PEP风险,并允许临床医生实时评估PEP风险,尽早提供预防性治疗措施。
BACKGROUND: Post-ERCP
pancreatitis is one of the most common adverse events in ERCP-related procedures. The purpose of this
study is to construct an online model to predict the risk of post-ERCP
pancreatitis in non-elderly patients with common bile duct stones through screening of relevant clinical parameters.
METHODS: A total of 919 cases were selected from 7154 cases from a major Chinese tertiary hospital. Multivariable logistic regression model was fitted using the variables selected by the LASSO regression from 28 potential predictor variables. The internal and external validation was assessed by evaluating the receiver operating characteristic curve and the area under curve. Restricted cubic spline modelling was used to explore non-linear associations. The interactive Web application developed for risk prediction was built using the R \"shiny\" package.
RESULTS: The incidence of post-ERCP
pancreatitis was 5.22% (48/919) and significantly higher in non-elderly patients with female, high blood pressure, the history of
pancreatitis, difficult intubation, endoscopic sphincterotomy, lower alkaline phosphatase and smaller diameter of common bile duct. The predictive performance in the test and external validation set was 0.915 (95% CI, 0.858-0.972) and 0.838 (95% CI, 0.689-0.986), respectively. The multivariate restricted cubic spline results showed that the incidence of
pancreatitis was increased at 33-50 years old, neutrophil percentage > 58.90%, hemoglobin > 131 g/L, platelet < 203.04 or > 241.40 × 109/L, total bilirubin > 18.39 umol / L, aspartate amino transferase < 36.56 IU / L, alkaline phosphatase < 124.92 IU / L, Albumin < 42.21 g / L and common bile duct diameter between 7.25 and 10.02 mm. In addition, a web server was developed that supports query for immediate PEP risk.
CONCLUSIONS: The visualized networked version of the above model is able to most accurately predict the risk of PEP in non-elderly patients with choledocholithiasis and allows clinicians to assess the risk of PEP in real time and provide preventive treatment measures as early as possible.