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. 2024 Sep 1;110(9):5595-5604.
doi: 10.1097/JS9.0000000000001655.

Nomogram for predicting intolerable postoperative early enteral nutrition following definitive surgery for small intestinal fistula: a cohort study

Weiliang Tian  1 , Lei Luo  2 , Xin Xu  3 , Risheng Zhao  3 , Tao Tian  4 , Wuhan Li  5 , Yunzhao Zhao  3 , Zheng Yao  3
Affiliations

Nomogram for predicting intolerable postoperative early enteral nutrition following definitive surgery for small intestinal fistula: a cohort study

Weiliang Tian et al. Int J Surg. .

Abstract

Background: This study was designed to develop and validate a nomogram for predicting intolerable early enteral nutrition (EEN) following definitive surgery (DS) for small intestinal fistula.

Methods: A total of 377 patients, recruited from January 2016 to September 2023, was randomly allocated into development ( n =251) and validation ( n =126) groups in a 2:1 ratio. Risk factors were identified using the nomogram. Its performance was assessed based on calibration, discrimination, and clinical utility, with validation confirming its effectiveness.

Results: Of the 377 patients, 87 (23.1%) were intolerant to EEN, including 59 (23.1%) in the development cohort and 28 (22.1%) in the validation cohort ( P =0.84). Four factors were identified as predictive of intolerable EEN: severe abdominal adhesion, deciliter of blood loss during DS, human serum albumin (Alb) input >40 g during and within 48 h post-DS, and the visceral fat area (VFA)/total abdominal muscle area index (TAMAI) ratio. The model demonstrated excellent discrimination, with a C-index of 0.79 (95% CI: 0.74-0.87, including internal validation) and robust calibration. In the validation cohort, the nomogram showed strong discrimination (C-index=0.77; 95% CI: 0.64-0.87) and solid calibration. Decision curve analysis affirmed the nomogram's clinical utility.

Conclusion: This research introduces a nomogram that enables the individualized prediction of intolerable EEN following DS for small intestinal fistula, demonstrating a possible clinical utility.

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Conflict of interest statement

The authors declare that they have no financial conflict of interest with regard to the content of this report.

Figures

Figure 1
Figure 1
Nomogram model predicating the intolerable early enternal nutrition. The nomogram was developed in the development cohort, with the severe abdominal ahesion, VFA/TAMAI, The amount of human serum Alb input >40 g during and within 48 h post-DS, Deciliter of bleeding during DS. Alb, Albumin; DS, definitive surgery; VFA/TAMAI, Visceral fat area / Total abdominal muscle area index.
Figure 2
Figure 2
(A) Calibration curve of the nomogram model in the development cohort. (B) Calibration curve of the nomogram in the validation cohort.
Figure 3
Figure 3
(A) Decision curve analysis for the nomogram model in the development cohort. (B) Decision curve analysis for the nomogram model in the validation cohort.
See this image and copyright information in PMC

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