Construction and validation of a risk prediction model for postoperative ICU admission in patients with colorectal cancer: Clinical prediction model study

Abstract

Abstract Background: ICU transfer is a common situation after all non-cardiac surgeries, including radical resection of colorectal cancer (CRC). It is important to understand the rational use of expensive ICU medical resources and supportive postoperative treatment. The purpose of this research was to construct and validate a nomogram to predict which patients would need immediate ICU admission after radical CRC resection. Methods: Data of 1003 patients who underwent radical resection or palliative surgery for CRC at Ningxia Medical University General Hospital from August 2020 to April 2022 were analyzed retrospectively. Patients were randomly allocated to training and validation queues (7:3, respectively). Using the least absolute shrinkage and selection operator (LASSO) approach and multivariate logistic regression, the nomogram was built by identifying independent predictors in the training cohort. An online prediction tool was generated for clinical application. Results: The final predictive model included: age (P = 0.003, odds ratio [OR] 3.623, 95% confidence interval [CI] 1.535–8.551); NRS2002 (P = 0.000, OR 6.129, 95% CI 2.920-12.863); ALB (P = 0.013, OR 0.921, 95% CI 0.863–0.982); atrial fibrillation (P = 0.000, OR 20.017, 95% CI 4.191–95.609); COPD (P = 0.009, OR 8.151, 95% CI 1.674–39.676); FEV1/FVC (P = 0.040, OR 0.966, 95% CI 0.935–0.998); and surgical method (P = 0.024, OR 0.425, 95% CI 0.202–0.891), among others. The nomogram's area under the curve and consistency index were 0.865 and 0.367, respectively. The Hosmer-Lemeshow test revealed that the model fit was excellent (P = 0.367). Predictive performance was confirmed by internal validation. Conclusion: Predictors of ICU admission after radical resection of CRC include: age, preoperative serum albumin level, nutritional risk screening, atrial fibrillation, chronic obstructive pulmonary disease, FEV one-second rate, and surgical route. Postoperative ICU admission risk prediction line chart and online web server facilitate clinical decision making on the need for postoperative ICU admission for patients undergoing radical colorectal cancer surgery. Trial registration: Despite the retrospective nature of this study, we have proactively registered it with the Chinese Clinical Trial Registry. The registration number is ChiCTR2200062210, and the date of registration is 29/07/2022.