Analysis of risk factors and development of a predictive model for postoperative pulmonary complications in hepatic echinococcosis patients

Abstract

Studies explicitly examining postoperative pulmonary complications (PPCs) following surgical interventions for hepatic echinococcosis are limited. In this paper, clinical data were retrospectively collected from patients with hepatic echinococcosis admitted to a Qinghai Provincial People's Hospital between January 2016 and June 2023. Among 1177 patients, 690 (58.6%) developed PPCs, with the incidence rate of Clavien-Dindo Grade II and upwards being 18.3%. Totally 7 independent risk factors for PPCs were identified by applying least absolute shrinkage and selection operator regression analysis and multivariate logistic regression: body mass index (BMI), pre-existing lung disease, focal diameter, mode of operation, antibiotic therapy within 1 month before surgery, the need for blood transfusion, and operation duration. Among these factors, mode of operation, the need for blood transfusion and operation duration were also identified as independent risk factors for PPCs with Clavien-Dindo Grade ≥ II. The developed nomogram prediction model (model 1) based on these independent factors accurately assesses the risk of PPCs. The nomogram's area under the receiver operating characteristic curve (AUC) was 0.808. Calibration plots and Hosmer-Lemeshow test demonstrated excellent consistency. Decision curve analysis indicated a net benefit for threshold probabilities between 18 and 99%. Furthermore, considering that the prevention and treatment of PPCs (Clavien-Dindo Grade ≥ II) might be more concerned in clinical work, we further established a nomogram prediction model (model2) by using PPCs of Clavien-Dindo Grade ≥ II as positive events. Its AUC was 0.744. Combined application of two models: PPCs risk < 18%: No therapeutic intervention required. PPCs risk 18-61.2%: Implement close monitoring and dynamic reassessment. PPCs risk > 61.2%: Initiate general treatments (e.g., chest physiotherapy, mucolytic agents). Concurrently apply model 2: If the calculated disease risk ≥ 18.6%, administer aggressive therapies (e.g., antibiotics, drainage procedures).

Keywords: Hepatic echinococcosis; Nomogram; Postoperative pulmonary complications; Prediction model; Risk factors.

Fig. 1

The nomogram constructed for predicting PPCs in hepatic echinococcosis. BMI body mass index, PPCs postoperative pulmonary complications.

Fig. 2

Receiver operating characteristic (ROC) curves for the prediction model ((a) training set; (b) validation set).

Fig. 3

Calibration plots for the model ((a) training set; (b) validation set).

Fig. 4

DCA for the model ((a) training set; (b) validation set).

Fig. 5

The nomogram constructed for predicting PPCs of Clavien-Dindo Grade ≥ II in hepatic echinococcosis.

Fig. 6

Evaluation results of PPCs (Clavien-Dindo Grade ≥ II) nomogram model ((a) ROC; (b) calibration plots; (c) DCA).