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ORIGINAL RESEARCH article

Front. Pediatr.
Sec. Neonatology
Volume 12 - 2024 | doi: 10.3389/fped.2024.1366913

Construction and evaluation of a risk model for adverse outcomes of necrotizing enterocolitis based on Lasso-Cox regression

Provisionally accepted
Haijin Zhang Haijin Zhang Yuan Yao Yuan Yao *
  • Qianjiang Maternal and Child Health Hospital, Qianjiang, China

The final, formatted version of the article will be published soon.

    Objective: This study aimed to develop a nomogram to predict adverse outcomes in neonates with necrotizing enterocolitis (NEC).In this retrospective study on neonates with NEC, data on perinatal characteristics, clinical features, laboratory findings, and X-ray examinations were collected for the included patients. A risk model and its nomogram were developed using the least absolute shrinkage and selection operator (LASSO) Cox regression analyses.: A total of 182 cases of NEC were included and divided into a training set (148 cases) and a temporal validation set (34 cases). Eight features, including weight [p = 0.471, HR = 0.99 (95% CI : 0.98 -1.00)], history of congenital heart disease [p < 0.001, HR = 3.13 (95% CI:1.75 -5.61)], blood transfusion before onset [p = 0.757, HR = 0.85 (95%CI:0.29 -2.45)], antibiotic exposure before onset [p = 0.003, HR = 5.52 (95% CI:1.81 -16.83)], C-reactive protein (CRP) at onset [p = 0.757, HR=1.01 (95%CI:1.00 -1.02)], plasma sodium at onset [p < 0.001, HR = 4.73 (95%CI:2.61 -8.59)], dynamic abdominal X-ray score change [p = 0.001, HR=4.90 (95%CI:2.69 -8.93)], and antibiotic treatment regimen [p=0.250, HR=1.83 (0.65 -5.15)], were ultimately selected for model building. The C-index for the predictive model was 0.850 (95% CI: 0.804-0.897) for the training set and 0.7880.788 (95% CI: 0.656-0.921) for the validation set. The area under the ROC curve (AUC) at 8-, 10-, and 12-days were 0.889 (95% CI: 0.822-0.956), 0.891 (95% CI: 0.829-0.953), and 0.893 (95% CI:0.832-0.954) in the training group, and 0.812 (95% CI: 0.633-0.991), 0.846 (95% CI: 0.695-0.998), and 0.798 (95%CI: 0.623-0.973) in the validation group, respectively. Calibration curves showed good concordance between the predicted and observed outcomes, and DCA demonstrated adequate clinical benefit.The LASSO-Cox model effectively identifies NEC neonates at high risk of adverse outcomes across all time points. Notably, at earlier time points (such as the 8-day mark), the model also demonstrates strong predictive performance, facilitating the early prediction of adverse outcomes in infants with NEC. This early prediction can contribute to timely clinical decision-making and ultimately improve patient prognosis.

    Keywords: necrotizing enterocolitis, Risk factors, prediction, abdominal x-ray, Cox proportional hazards regression, nomogram

    Received: 07 Jan 2024; Accepted: 20 Sep 2024.

    Copyright: © 2024 Zhang and Yao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Yuan Yao, Qianjiang Maternal and Child Health Hospital, Qianjiang, China

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