| Objective:This study mainly analyzes the risk factors of intestinal fistula in middle-aged and young patients with severe acute pancreatitis(SAP),constructs its related risk prediction model,and verifies the clinical prediction effect of the prediction model.It provides a scientific early evaluation and screening tool for reducing the incidence of intestinal fistula in middle-aged and young SAP patients and reducing the consumption of medical and health resources,It also provides scientific reference for clinical nursing personnel to take preventive management measures in a timely manner.Methods:A retrospective method was used to collect relevant clinical data of patients who met the diagnostic,inclusion,and exclusion criteria from the Department of Gastroenterology in a Class III Class A hospital in Changchun City from January 2016 to December 2021.According to the medical records,patients were divided into intestinal fistula group and non intestinal fistula group according to whether they were complicated with intestinal fistula.A total of 314 patients were included in this study,and the 314 patients who met the criteria for inclusion in the study were divided using a random number table method according to a 7:3 ratio of the modeling and validation queues.By querying the literature on risk factors of intestinal fistula in middle-aged and young SAP patients in electronic databases at home and abroad,and combining group discussions,consulting experts,and clinical status,we selected relevant risk factors that may affect the incidence of intestinal fistula in middle-aged and young SAP patients.We also designed and developed a questionnaire for patients’general and clinical data,and collected relevant information about patients who met the standards through the hospital electronic medical record information system.SPSS software was used for statistical analysis,and logistic regression analysis was used to construct a risk prediction model.After single factor analysis and multivariate logistic regression analysis,the independent risk factors for intestinal fistula in middle-aged and young SAP patients were determined,and the calculation formula for the risk prediction model was obtained,and the relevant risk prediction model was constructed.The goodness of fit of the risk prediction model was evaluated using the Hosmer Lemeshow(H-L)chi-square test.The receiver operator characteristic curve(ROC)of the subject determined the Jordan index,sensitivity,specificity,and optimal critical value of the risk prediction model.The area under the curve(AUC)tested the discrimination of the risk prediction model,and calculated the total accuracy of the prediction model.Results:(1)A total of 314 patients who met the criteria were included in this study.Among them,there were 220 patients in the modeling group and 94 patients in the validation group.A total of 82 patients(58 in the modeling group and 24 in the validation group)developed intestinal fistula,with an incidence of 26.1%.(2)Single factor analysis showed that secondary pancreatic infection,extrapancreatic inflammation,long-term use of large amounts of hormones,Hypoproteinemia,and nutritional support were risk factors associated with intestinal fistula(P<0.05).Therefore,these five risk factors were included in multivariate logistic regression analysis.Other remaining indicators showed no significant difference between the two groups in the intestinal fistula group and the non intestinal fistula group(P>0.05)(3)Multivariate Logistic regression analysis showed that secondary pancreatic infection,hypoproteinemia and nutritional support were independent risk factors for intestinal fistula in young and middle-aged SAP patients(P<0.05).(4)According to the partial regression coefficient of independent risk factors in the binary logistic regression analysis results,the regression equation of the risk prediction model for intestinal fistula in middle-aged and young SAP patients was fitted to complete the construction of the risk prediction model.The mathematical calculation formula for forming a risk prediction model is:logit(P)=-3.442+1.783×Pancreatic infection(=0 or 1)+1.829×Hypoproteinemia(=0 or 1)+1.270×Nutritional support(=0 or 1)(5)To validate the prevalence of intestinal fistula in young SAP patients in the modeling and validation cohorts,the prediction model had an area under the working characteristic curve(AUC)of 0.852(95%CI:0.796 to 0.908,P<0.001),a sensitivity of77.6%,and a specificity of 93.2%.The results of the Hosmer Lemeshow(H-L)test showed that:χ~2=4.960,P=0.665;The area under the work characteristic curve(AUC)of the subjects in the validation cohort was AUC=0.753(95%CI:0.635 to 0.871,P<0.001),with a sensitivity of 91.7%,and a specificity of 91.4%.The results of the Hosmer-Lemeshow(H-L)test showed that:χ~2=12.198,P=0.143。There was no significant difference in the goodness of fit test between the modeling cohort and the validation cohort of the prediction model(P>0.05),indicating that the predicted risk profile of the model was highly consistent with the actual risk profile.The overall accuracy of the validation queue model is 91.5%,which proves that the prediction model has high discrimination accuracy and reliability.Conclusion:1.Secondary pancreatic infection,extrapancreatic inflammatory invasion,long-term use of large amounts of hormones,hypoproteinemia,and nutritional support were the risk factors for intestinal fistula in young and middle-aged SAP patients,while secondary pancreatic infection,hypoproteinemia,and nutritional support were the independent risk factors for intestinal fistula in young and middle-aged SAP patients.2.The risk prediction model for middle-aged and young SAP patients complicated with intestinal fistula has high discrimination accuracy and discrimination.Therefore,the risk prediction model can be used to identify high-risk groups and predict the risk of complicated intestinal fistula,which has certain clinical application value. |
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