Predicting Strangulation Risk in Acute Irreducible Inguinal Hernias: Development and Validation of an Integrated Model Using Inflammatory Markers and Imaging Features

IF 2 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

International Journal of Clinical Practice Pub Date : 2026-10-04 DOI:10.1155/ijcp/4920030

Yongzheng Xie, Haiyun Deng, Zhaohui Shi, Meng Wang, Binjie Wang, Changbo Li, Li Zheng

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引用次数: 0

Abstract

Purpose

Accurately predicting strangulation risk in acute irreducible inguinal hernia remains a clinical challenge. This study aimed to develop and validate an integrated model using routinely available inflammatory markers and imaging features for preoperative risk assessment.

Methods

We conducted a retrospective cohort study of adults with acute irreducible inguinal hernia at a single center (January 2020–August 2024). Predictors were drawn from clinical, laboratory (including inflammatory indices) and imaging domains. We employed a three-stage analytical framework: (1) univariate screening with t-tests or Mann–Whitney U tests, (2) variable refinement using LASSO regression on significant univariate predictors, and (3) definitive model construction via multivariable logistic regression. Model performance was evaluated by its area under the curve (AUC), calibration (calibration plot and Hosmer–Lemeshow test), and clinical utility (net benefit on decision curve analysis, DCA). Model stability was assessed through 10-fold cross-validation and 1000 bootstrap internal validations.

Results

From 988 screened hernia patients, 84 met the inclusion criteria. The intraoperative findings confirmed bowel strangulation in 40 patients (47.6%). The final model, the Inguinal Hernia Strangulation Risk Score (IHS-RS), incorporated five independent predictors: pelvic effusion (odds ratio [OR]: 8.77), age cohort (OR: 2.12), femoral hernia (vs. nonfemoral) (OR: 2.28), neutrophil count (OR: 1.26), and blood urea nitrogen (OR: 1.19). The model showed strong discrimination with an apparent AUC of 0.847 (95% CI: 0.762–0.933) and an internally validated AUC of 0.790 on 10-fold cross-validation, good calibration (Hosmer–Lemeshow test p = 0.809), and provided a positive net clinical benefit across a range of threshold probabilities on DCA.

Conclusion

The IHS-RS, integrating five readily available preoperative variables, offers a practical tool for preoperative risk stratification. It has the potential to aid surgical planning and optimize triage and referral decisions for frontline clinicians managing acute irreducible inguinal hernia.

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预测急性难治性腹股沟疝的绞窄风险：利用炎症标志物和影像学特征的综合模型的开发和验证

目的准确预测急性难治性腹股沟疝绞窄风险仍是一个临床难题。本研究旨在开发和验证一个综合模型，利用常规可用的炎症标志物和影像学特征进行术前风险评估。方法：我们在单一中心（2020年1月- 2024年8月）对成人急性无法治愈的腹股沟疝进行回顾性队列研究。预测因子来自临床、实验室（包括炎症指数）和影像学领域。我们采用了三阶段分析框架：(1)使用t检验或Mann-Whitney U检验进行单变量筛选，(2)对重要单变量预测因子使用LASSO回归进行变量细化，(3)通过多变量逻辑回归构建确定模型。通过曲线下面积（AUC）、校正（校正图和Hosmer-Lemeshow检验）和临床效用（决策曲线分析的净效益，DCA）来评价模型的性能。通过10次交叉验证和1000次自举内部验证来评估模型的稳定性。结果988例疝患者中，84例符合纳入标准。术中结果证实40例（47.6%）患者为肠绞窄。最后的模型是腹股沟疝扼杀风险评分（IHS-RS），纳入了五个独立的预测因素：盆腔积液（优势比[OR]: 8.77）、年龄队列（OR: 2.12）、股疝（相对于非股疝）（OR: 2.28）、中性粒细胞计数（OR: 1.26）和血尿素氮（OR: 1.19）。该模型具有很强的辨别能力，10倍交叉验证的表观AUC为0.847 (95% CI: 0.762-0.933)，内部验证的AUC为0.790，校准良好（Hosmer-Lemeshow检验p = 0.809），并且在DCA的阈值概率范围内提供了积极的净临床效益。结论IHS-RS综合了5个术前变量，为术前风险分层提供了实用工具。它有可能帮助外科计划和优化分诊和转诊决定的一线临床医生管理急性不可还原性腹股沟疝。

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

International Journal of Clinical Practice 医学-医学：内科

CiteScore

5.30

自引率

0.00%

发文量

274

审稿时长

3-8 weeks

期刊介绍： IJCP is a general medical journal. IJCP gives special priority to work that has international appeal. IJCP publishes: Editorials. IJCP Editorials are commissioned. [Peer reviewed at the editor''s discretion] Perspectives. Most IJCP Perspectives are commissioned. Example. [Peer reviewed at the editor''s discretion] Study design and interpretation. Example. [Always peer reviewed] Original data from clinical investigations. In particular: Primary research papers from RCTs, observational studies, epidemiological studies; pre-specified sub-analyses; pooled analyses. [Always peer reviewed] Meta-analyses. [Always peer reviewed] Systematic reviews. From October 2009, special priority will be given to systematic reviews. [Always peer reviewed] Non-systematic/narrative reviews. From October 2009, reviews that are not systematic will be considered only if they include a discrete Methods section that must explicitly describe the authors'' approach. Special priority will, however, be given to systematic reviews. [Always peer reviewed] ''How to…'' papers. Example. [Always peer reviewed] Consensus statements. [Always peer reviewed] Short reports. [Always peer reviewed] Letters. [Peer reviewed at the editor''s discretion] International scope IJCP publishes work from investigators globally. Around 30% of IJCP articles list an author from the UK. Around 30% of IJCP articles list an author from the USA or Canada. Around 45% of IJCP articles list an author from a European country that is not the UK. Around 15% of articles published in IJCP list an author from a country in the Asia-Pacific region.