Novel Multiparametric Nomogram for Overall Survival Prediction in Complicated Intra-Abdominal Infection: A Multicenter Study in China.

Sisi Huang,Sheng Zhang,Jiao Liu,Zhenliang Wen,Dechang Chen,Yizhu Chen,Lidi Zhang,Limin Chen

doi:10.3389/fmed.2021.627416

Sisi Huang, Sheng Zhang + Show 6 more

Open Access

https://doi.org/10.3389/fmed.2021.627416

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Abstract

Background: Complicated intra-abdominal infections (cIAIs) in the abdominal cavity or within an abdominal organ are numerous and frequent dangerous entities in the treatment of critically ill patients. Early clinical evaluation is necessary.Methods: This retrospective multicenter study included patients from 10 intensive care units (ICUs). Risk factors for the overall survival (OS) of patients with cIAI were selected using least absolute shrinkage and selection operator regression, and a nomogram was constructed subsequently. Calibration curve and receiver operating characteristic (ROC) curve were used to evaluate the calibration and discriminative ability.Results: In total, 544 patients diagnosed with cIAI were enrolled and divided into the study (n = 276) and validation (n = 268) sets. Sex, acute gastrointestinal injury, acute kidney injury, rare bacterium infection, Charlson score, and APACHE II score were identified as independent risk factors and were constructed for the nomogram. The nomogram showed marked calibration capability with a concordance index (C-index) of 0.909 and 0.831 in the study and validation set, respectively. Compared with the common clinical prognostic scoring system, the nomogram achieved the highest discrimination ability with an area under the curve (AUC) value of 0.91 and 0.83 in the study set and validation set, respectively.Conclusions: Our newly constructed nomogram provides a useful tool for risk stratification and prognosis evaluation of cIAI.

Highlights

Intra-abdominal infections (IAIs) are responsible for nearly 20% of sepsis cases and are the second most common cause of infectious morbidity and mortality after pneumonia in intensive care units (ICUs) [1]
Of 631 patients who was confirmed with Complicated intra-abdominal infections (cIAI), 544 patients were eligible for analysis (Figure 1)
acute gastrointestinal injury (AGI), acute kidney injury (AKI), rare bacterium infection, Charlson score, and APACHE II score were identified as the risk factors, and were used to constitute the nomogram for prognosis prediction of cIAI in the study cohort

Summary

Introduction

Intra-abdominal infections (IAIs) are responsible for nearly 20% of sepsis cases and are the second most common cause of infectious morbidity and mortality after pneumonia in intensive care units (ICUs) [1]. Complicated intra-abdominal infections (cIAI) are more likely to cause drug-resistant bacterium infections, surrounding organ damage, and even systemic inflammatory reactions, subsequently contributing to the accumulation of hospitalization costs, length of stay, and morbidity [2, 3]. Several risk factors including delayed interventions, antibiotic-resistant pathogens, high severity of illness, advanced age, poor nutritional status, and pre-existing chronic medical conditions have been reported to cause treatment failure [6,7,8,9]. Oddeke [10] reported that “none of the widely-used scoring systems to predict overall outcome in critically ill patients are of clinical value.”. Complicated intra-abdominal infections (cIAIs) in the abdominal cavity or within an abdominal organ are numerous and frequent dangerous entities in the treatment of critically ill patients.

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