Analysis Of Risk Factors And Construction Of Prediction Model Of Gangrene And Perforation In Children With Acute Appendicitis

Objective: To explore the risk factors leading to the gangrene and perforation of the appendix in children with acute appendicitis,and to establish and verify a prediction model for the risk of gangrene and perforation of the appendix in children with acute appendicitis,in order to provide reference for the diagnosis of gangrene and perforation in acute appendicitis,so as to choose the best treatment method and improve the prognosis.Methods: A retrospective case-control study was conducted to collect the clinical data of 452 children with acute appendicitis who were hospitalized in the Department of Pediatric Surgery of the Affiliated Hospital of Jining Medical College from January 2017 to February 2021 and met the inclusion and exclusion criteria.According to whether the appendix was gangrenous or perforated during the operation and the postoperative pathological results,the children were divided into gangrene and perforation group and non-gangrene and perforation group.Two groups were compared for age,gender,body mass index(BMI),time from onset to admission,maximum body temperature before admission,vomit,diarrhea,neutrophil/lymphocyte ratio(NLR),C-reactive protein(CRP),mean platelet volume(MPV),white blood cell(WBC)count,platelet distribution width(PDW),albumin(ALB),total bilirubin(TBil),fibrinogen(FIB),preoperative ultrasound was used to detect whether or not there is fecal stone in the appendix.Through univariate binary logistic regression analysis,the statistically significant observation indicators were screened out.And then these observation indicators were included in the multivariate binary logistic regression analysis to screen out the independent predictors of gangrene and perforation in children with acute appendicitis.Further,a corresponding nomogram prediction model was constructed by Empowerstats software.The reliability of the model was assessed using receiver operating characteristic(ROC)curves and calibration curve.Results:A total of 452 cases of acute appendicitis in children meeting the criteria were included in this study,including 232 cases of gangrene and perforation,220 cases of non-gangrene and perforation,with a gangrene perforation rate of 51.33%.The results of univariate binary logistic regression analysis showed that: age,BMI,maximum body temperature before admission,vomit,WBC,NLR,CRP,ALB,TBil,FIB,preoperative ultrasound detected fecal stone in the appendix were the relevant risk factors for gangrene and perforation in children with acute appendicitis(P<0.05).The results of multivariate binary logistic regression analysis showed that: the maximum body temperature before admission exceeding38℃(OR=2.243,95%CI:1.264-3.981,P=0.006),preoperative ultrasound detected fecal stone in the appendix(OR=6.183,95%CI:3.532-10.825,P<0.001),NLR(OR=1.150,95%CI : 1.081-1.224,P<0.001),CRP(OR=1.011,95%CI:1.004-1.018,P=0.001),FIB(OR=1.780,95%CI:1.229-2.577,P=0.002)were independent risk factors for gangrene and perforation in children with acute appendicitis.Based on the above five independent risk factors,a nomogram prediction model for gangrene and perforation in children with acute appendicitis was constructed.The area under the ROC curve(AUC)was0.898,95%CI was 0.870-0.927.The internal verification results of the model by Bootstrap method for 500 times showed that the predicted calibration curve is in good agreement with the standard curve,and the model Hosmer-Lemeshow goodness of fit test results P>0.05,suggesting that the model had better discrimination and calibration in predicting gangrene and perforation in children with acute appendicitis.Conclusion: The nomogram prediction model based on the maximum body temperature before admission exceeding 38℃,preoperative ultrasound detected fecal stone in the appendix,NLR,CRP and FIB can more intuitively,quickly and effectively predict the risk of gangrene and perforation in children with acute appendicitis.It can help clinicians early identify high-risk children with gangrene and perforation of the appendix,so as to guide the treatment of appendicitis.