Abstract
Purpose Sepsis is a severe complication in patients following major hepatobiliary and pancreatic surgery. The purpose of this study was to develop and validate a nomogram based on inflammation biomarkers and clinical characteristics. Methods Patients who underwent major hepatobiliary and pancreatic surgery between June 2015 and April 2017 were retrospectively collected. Multivariate logistic regression was used to identify the independent risk factors associated with postoperative sepsis. A training cohort of 522 patients in an earlier period was used to develop the prediction models, and a validation cohort of 136 patients thereafter was used to validate the nomograms. Results Sepsis developed in 55 of 522 patients of the training cohort and 19 of 136 patients in the validation cohort, respectively. In the training cohort, one nomogram based on clinical characteristics was developed. The clinical independent risk factors for postoperative sepsis include perioperative blood transfusion, diabetes, operative time, direct bilirubin, and BMI. Another nomogram was based on both clinical characteristics and inflammation biomarkers. Multivariate regression analyses showed that previous clinical risk factors, PCT, and CRP were independent risk factors for postoperative sepsis. The last nomogram showed a good C-index of 0.844 (95% CI, 0.787-0.900) compared with the previous one of 0.777 (95% CI, 0.713-0.840). Patients with a total score more than 109 in the second model are at high risk. The positive predictive value and negative predictive value of the second nomogram were 27% and 97%, respectively. Conclusion The nomogram achieved good performances for predicting postoperative sepsis in patients by combining clinical and inflammation risk factors. This model can provide the early risk estimation of sepsis for patients following major hepatobiliary and pancreatic surgery.
Highlights
Severe sepsis and organ failure are major causes of morbidity and mortality after major hepatobiliary and pancreatic surgery [1]
We aim to develop and validate nomograms to predict sepsis of patients following major hepatobiliary and pancreatic surgery
A total of 658 patients who underwent major hepatobiliary and pancreatic surgery and met the inclusion criteria were included. 522 patients and 136 patients were divided into the training and validation groups, respectively
Summary
Severe sepsis and organ failure are major causes of morbidity and mortality after major hepatobiliary and pancreatic surgery [1]. In one study of 1933 patients who underwent PD (pancreaticoduodenectomy), sepsis was found in 482 patients (24.9%) [3]. With advances in monitoring and prompt initiation of therapy, the mortality of severe sepsis remains higher than 25%~30%, even reaching 40-50% in the presence of shock [4]. These patients who survive to hospital discharge after sepsis are still at risk for death in the following time [5]. Those who survive often suffer from impaired physical or neurocognitive functions, emotional disorders, and a poor quality of life [6]
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