Development of a nomogram for the prediction of complicated appendicitis during pregnancy
Abstract Background Complicated appendicitis during pregnancy directly affects the clinical prognosis of both mother and fetus. However, accurate identification of complicated appendicitis in pregnancy is fraught with various challenges. The purpose of this study was to identify the risk factors and...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | BMC Surgery |
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| Online Access: | https://doi.org/10.1186/s12893-023-02064-w |
| _version_ | 1827910986852466688 |
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| author | Xiaosong Zheng Xiaojun He |
| author_facet | Xiaosong Zheng Xiaojun He |
| author_sort | Xiaosong Zheng |
| collection | DOAJ |
| description | Abstract Background Complicated appendicitis during pregnancy directly affects the clinical prognosis of both mother and fetus. However, accurate identification of complicated appendicitis in pregnancy is fraught with various challenges. The purpose of this study was to identify the risk factors and to develop a useful nomogram to predict complicated appendicitis during pregnancy. Methods This retrospective study involved pregnant women who underwent appendectomy at the Maternal and Child Health Hospital of Hubei Provincial from May 2016 to May 2022 and who ultimately had histopathological confirmed acute appendicitis. Univariate and multivariate logistic regression were applied to analyze clinical parameters and imaging features as a way to identify risk factors. Then, nomogram and scoring systems predicting complicated appendicitis in pregnancy were constructed and evaluated. Finally, the potential non-linear association between risk factors and complicated appendicitis was analyzed using restricted cubic splines. Results Three indicators were finally identified for the construction of the nomogram: gestational weeks, C-reactive protein (CRP), and neutrophil percentage (NEUT%). To improve the clinical utility, the gestational weeks were divided into three periods (first trimesters, second trimesters, and third trimesters), while the optimal cut-offs for CRP level and NEUT% were found to be 34.82 mg/L and 85.35%, respectively. Multivariate regression analysis showed that third trimesters (P = 0.013, OR = 16.81), CRP level ≥ 34.82 mg/L (P = 0.007, OR = 6.24) and NEUT% ≥85.35% (P = 0.011, OR = 18.05) were independent risk factors for complicated appendicitis. The area under the ROC curve (AUC) of the nomogram predicting complicated appendicitis in pregnancy was 0.872 (95% CI: 0.803–0.942). In addition, the model was shown to have excellent predictive performance by plotting calibration plots, Decision Curve Analysis (DCA), and clinical impact curves. When the optimal cut-off point of the scoring system was set at 12, the corresponding AUC, sensitivity, specificity, Positive Likelihood Ratio (PLR), Negative Likelihood Ratio (NLR), Positive Predictive Value (PPV), and Negative Predictive Value (NPV) values were AUC: 0.869(95% CI: 0.799–0.939),100%, 58.60%, 2.41, 0, 42%, and 100%, respectively. The restricted cubic splines revealed a linear relationship between these predictors and complicated appendicitis during pregnancy. Conclusions The nomogram utilizes a minimum number of variables to develop an optimal predictive model. Using this model, the risk of developing complicated appendicitis in individual patients can be determined so that reasonable treatment choices can be made. |
| first_indexed | 2024-03-13T01:58:00Z |
| format | Article |
| id | doaj.art-0c4b5ae8ad0c40d1a920f456fdcbcee4 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-03-13T01:58:00Z |
| publishDate | 2023-07-01 |
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| series | BMC Surgery |
| spelling | doaj.art-0c4b5ae8ad0c40d1a920f456fdcbcee42023-07-02T11:05:34ZengBMCBMC Surgery1471-24822023-07-012311910.1186/s12893-023-02064-wDevelopment of a nomogram for the prediction of complicated appendicitis during pregnancyXiaosong Zheng0Xiaojun He1Department of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and TechnologyDepartment of General Surgery, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and TechnologyAbstract Background Complicated appendicitis during pregnancy directly affects the clinical prognosis of both mother and fetus. However, accurate identification of complicated appendicitis in pregnancy is fraught with various challenges. The purpose of this study was to identify the risk factors and to develop a useful nomogram to predict complicated appendicitis during pregnancy. Methods This retrospective study involved pregnant women who underwent appendectomy at the Maternal and Child Health Hospital of Hubei Provincial from May 2016 to May 2022 and who ultimately had histopathological confirmed acute appendicitis. Univariate and multivariate logistic regression were applied to analyze clinical parameters and imaging features as a way to identify risk factors. Then, nomogram and scoring systems predicting complicated appendicitis in pregnancy were constructed and evaluated. Finally, the potential non-linear association between risk factors and complicated appendicitis was analyzed using restricted cubic splines. Results Three indicators were finally identified for the construction of the nomogram: gestational weeks, C-reactive protein (CRP), and neutrophil percentage (NEUT%). To improve the clinical utility, the gestational weeks were divided into three periods (first trimesters, second trimesters, and third trimesters), while the optimal cut-offs for CRP level and NEUT% were found to be 34.82 mg/L and 85.35%, respectively. Multivariate regression analysis showed that third trimesters (P = 0.013, OR = 16.81), CRP level ≥ 34.82 mg/L (P = 0.007, OR = 6.24) and NEUT% ≥85.35% (P = 0.011, OR = 18.05) were independent risk factors for complicated appendicitis. The area under the ROC curve (AUC) of the nomogram predicting complicated appendicitis in pregnancy was 0.872 (95% CI: 0.803–0.942). In addition, the model was shown to have excellent predictive performance by plotting calibration plots, Decision Curve Analysis (DCA), and clinical impact curves. When the optimal cut-off point of the scoring system was set at 12, the corresponding AUC, sensitivity, specificity, Positive Likelihood Ratio (PLR), Negative Likelihood Ratio (NLR), Positive Predictive Value (PPV), and Negative Predictive Value (NPV) values were AUC: 0.869(95% CI: 0.799–0.939),100%, 58.60%, 2.41, 0, 42%, and 100%, respectively. The restricted cubic splines revealed a linear relationship between these predictors and complicated appendicitis during pregnancy. Conclusions The nomogram utilizes a minimum number of variables to develop an optimal predictive model. Using this model, the risk of developing complicated appendicitis in individual patients can be determined so that reasonable treatment choices can be made.https://doi.org/10.1186/s12893-023-02064-wNomogramComplicated appendicitisPregnancy |
| spellingShingle | Xiaosong Zheng Xiaojun He Development of a nomogram for the prediction of complicated appendicitis during pregnancy BMC Surgery Nomogram Complicated appendicitis Pregnancy |
| title | Development of a nomogram for the prediction of complicated appendicitis during pregnancy |
| title_full | Development of a nomogram for the prediction of complicated appendicitis during pregnancy |
| title_fullStr | Development of a nomogram for the prediction of complicated appendicitis during pregnancy |
| title_full_unstemmed | Development of a nomogram for the prediction of complicated appendicitis during pregnancy |
| title_short | Development of a nomogram for the prediction of complicated appendicitis during pregnancy |
| title_sort | development of a nomogram for the prediction of complicated appendicitis during pregnancy |
| topic | Nomogram Complicated appendicitis Pregnancy |
| url | https://doi.org/10.1186/s12893-023-02064-w |
| work_keys_str_mv | AT xiaosongzheng developmentofanomogramforthepredictionofcomplicatedappendicitisduringpregnancy AT xiaojunhe developmentofanomogramforthepredictionofcomplicatedappendicitisduringpregnancy |