Development and validation of a nomogram for predicting pulmonary complications in elderly patients undergoing thoracic surgery

IF 3.4 3区医学 Q2 GERIATRICS & GERONTOLOGY

Aging Clinical and Experimental Research Pub Date : 2024-10-05 DOI:10.1007/s40520-024-02844-1

Jingjing Liu, Dinghao Xue, Long Wang, Yanxiang Li, Luyu Liu, Guosong Liao, Jiangbei Cao, Yanhong Liu, Jingsheng Lou, Hao Li, Yongbin Yang, Weidong Mi, Qiang Fu

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Abstract

Background

Postoperative pulmonary complications (PPCs) remain a prevalent concern among elderly patients undergoing surgery, with a notably higher incidence observed in elderly patients undergoing thoracic surgery. This study aimed to develop a nomogram to predict the risk of PPCs in this population.

Methods

A total of 2963 elderly patients who underwent thoracic surgery were enrolled and randomly divided into a training cohort (80%, n = 2369) or a validation cohort (20%, n = 593). Univariate and multivariate logistic regression analyses were conducted to identify risk factors for PPCs, and a nomogram was developed based on the findings from the training cohort. The validation cohort was used to validate the model. The predictive accuracy of the model was evaluated by receiver operating characteristic (ROC) curve, area under ROC (AUC), calibration curve, and decision curve analysis (DCA).

Results

A total of 918 (31.0%) patients reported PPCs. Nine independent risk factors for PPCs were identified: preoperative presence of chronic obstructive pulmonary disease (COPD), elevated leukocyte count, higher partial pressure of arterial carbon dioxide (PaCO₂) level, surgical site, thoracotomy, intraoperative hypotension, blood loss > 100 mL, surgery duration > 180 min, and malignant tumor. The AUC value for the training cohort was 0.739 (95% CI: 0.719–0.762), and it was 0.703 for the validation cohort (95% CI: 0.657–0.749). The P-values for the Hosmer-Lemeshow test were 0.633 and 0.144 for the training and validation cohorts, respectively, indicating a notable calibration curve fit. The DCA curve indicated that the nomogram could be applied clinically if the risk threshold was between 12% and 84%, which was found to be between 8% and 82% in the validation cohort.

Conclusion

This study highlighted the pressing need for early detection of PPCs in elderly patients undergoing thoracic surgery. The nomogram exhibited promising predictive efficacy for PPCs in elderly patients undergoing thoracic surgery, enabling the identification of high-risk patients and consequently aiding in the implementation of preventive interventions.

Graphical Abstract

Abstract Image

查看原文本刊更多论文

开发并验证用于预测接受胸外科手术的老年患者肺部并发症的提名图。

背景：术后肺部并发症（PPCs）仍然是接受手术的老年患者普遍关注的问题，在接受胸外科手术的老年患者中发病率明显更高。本研究旨在开发一种预测该人群肺部并发症风险的提名图：共招募了 2963 名接受胸外科手术的老年患者，并将其随机分为训练队列（80%，n = 2369）或验证队列（20%，n = 593）。进行了单变量和多变量逻辑回归分析，以确定 PPCs 的风险因素，并根据训练队列的结果绘制了提名图。验证队列用于验证模型。通过接收者操作特征曲线（ROC）、ROC下面积（AUC）、校准曲线和决策曲线分析（DCA）评估了模型的预测准确性：共有 918 名（31.0%）患者报告了 PPCs。结果：共有 918 名患者（31.0%）报告了 PPCs，其中有 9 个独立的风险因素：术前患有慢性阻塞性肺病（COPD）、白细胞计数升高、动脉二氧化碳分压（PaCO2）水平升高、手术部位、开胸手术、术中低血压、失血量大于 100 毫升、手术时间大于 180 分钟以及恶性肿瘤。训练队列的 AUC 值为 0.739（95% CI：0.719-0.762），验证队列的 AUC 值为 0.703（95% CI：0.657-0.749）。训练队列和验证队列的 Hosmer-Lemeshow 检验 P 值分别为 0.633 和 0.144，表明校准曲线拟合效果显著。DCA曲线表明，如果风险阈值在12%到84%之间，提名图就可以应用于临床，而在验证队列中，风险阈值在8%到82%之间：本研究强调了对接受胸外科手术的老年患者进行 PPC 早期检测的迫切需要。该提名图对接受胸外科手术的老年患者的 PPC 具有良好的预测效果，能够识别高风险患者，从而有助于实施预防性干预措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Aging Clinical and Experimental Research 医学-老年医学

CiteScore

7.90

自引率

5.00%

发文量

283

审稿时长

1 months

期刊介绍： Aging clinical and experimental research offers a multidisciplinary forum on the progressing field of gerontology and geriatrics. The areas covered by the journal include: biogerontology, neurosciences, epidemiology, clinical gerontology and geriatric assessment, social, economical and behavioral gerontology. “Aging clinical and experimental research” appears bimonthly and publishes review articles, original papers and case reports.