Analysis of the predictors of surgical treatment and intestinal necrosis in children with intestinal obstruction
Analysis of the predictors of surgical treatment and intestinal necrosis in children with intestinal obstruction
复制标题
肠梗阻患儿手术治疗及肠坏死的预测因素分析
DOI：
10.1016/j.jpedsurg.2020.07.017
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发表时间：
2020-12-01
影响因子：
2.4
通讯作者：
Zhang, Shouhua
中科院分区：
文献类型：
--
作者：
Chen, Weilong;Xiao, Juhua;Zhang, Shouhua
目的：通过分析血生化指标，探讨肠梗阻患儿肠坏死的手术治疗及预测因素，建立预测模型，并评价其预测准确性、敏感性和特异性。方法：回顾性分析2014年1月至2019年6月在江西省儿童医院住院的肠梗阻患儿资料。结果：保守治疗成功的患儿与需要手术治疗的患儿血液中36种物质有显著性差异。该模型由年龄、白色血细胞计数、肌酸激酶、肌钙蛋白I、肌红蛋白、C反应蛋白和纤维蛋白原7个变量组成，可用于预测肠梗阻患儿保守治疗不成功而需进一步手术的可能性。平均预测准确率为83.50%，假阳性率为16.67%（32/192），AUROC = 0.9160（95% CI，0.8930 - 0.9390），敏感性和特异性分别为83.20%和92.70%。基于白色血细胞计数、肌酸激酶、肌钙蛋白I和肌红蛋白的预测模型可以预测肠坏死的发生。平均预测准确率为73.70%，假阳性率为4.49%（15/334），AUROC为0.7390（95%CI，0.6820-0.7960），敏感性和特异性分别为71.70%和64.70%。结合年龄、白色细胞计数、肌酸激酶、肌钙蛋白I、肌红蛋白、C反应蛋白、纤维蛋白原可预测肠梗阻患儿是否需要手术治疗。白细胞计数、肌酸激酶、肌钙蛋白I和肌红蛋白与肠梗阻患儿病情密切相关，可用于预测是否发生肠坏死。(C)2020爱思唯尔公司All rights reserved.
Purpose: To explore the surgical treatment and predictors of intestinal necrosis in children with intestinal obstruction through analyzing blood biochemical indicators, and to establish a predictive model and evaluate its predictive accuracy, sensitivity and specificity.Methods: The data of children with intestinal obstruction hospitalized in Jiangxi Provincial Children's Hospital from January 2014 to June 2019 were retrospectively analyzed.Results: Thirty-six substances in the blood of children with successful conservative management and those requiring surgical treatment were significantly different. The model composed of 7 variables, including age, white blood cell count, creatine kinase, troponin I, myoglobin, C-reactive protein and fibrinogen, can be used to predict the unsuccessful conservative management in children with intestinal obstruction, whom need further operation. The average prediction accuracy was 83.50%, the false positive rate was 16.67% (32/192), AUROC is 0.9160 (95% CI, 0.8930-0.9390), and the sensitivity and specificity were 83.20% and 92.70% respectively. A prediction model based on the white blood cell count, creatine kinase, troponin I and myoglobin could predict the occurrence of intestinal necrosis. The average prediction accuracy was 73.70%, false positive rate was 4.49% (15/334), AUROC was 0.7390 (95% CI, 0.6820-0.7960), and the sensitivity and specificity were 71.70% and 64.70%, respectively.Conclusions: Combination of age, white blood cell count, creatine kinase, troponin I, myoglobin, C-reactive protein and fibrinogen can be used to predict whether the children with intestinal obstruction need surgical treatment or not. Leukocyte count, creatine kinase, troponin I and myoglobin are closely related to the condition of children with intestinal obstruction and can be used to predict whether intestinal necrosis occurs. (C) 2020 Elsevier Inc. All rights reserved.