Prediction model construction and application value evaluation of postoperative metabolic acidosis in patients with intestinal cancer

doi:10.3877/cma.j.issn.2095-2015.2025.01.007

Abstract

Abstract:

Objective

To construct a predictive model of postoperative metabolic acidosis in patients with colorectal cancer and evaluate its application value.

Methods

A total of 271 patients with colorectal cancer admitted to Shuyang Hospital Affiliated to Nanjing University of Traditional Chinese Medicine from January 2020 to December 2022 were included. According to the occurrence of postoperative metabolic acidosis, the patients were divided into occurrence group and non-occurrence group. The clinical data of the two groups were compared, and the related factors affecting postoperative metabolic acidosis in patients with intestinal cancer were summarized by Logistic multivariate regression model. Based on the risk factors, the Nomogram prediction model was established and applied to the prediction of postoperative metabolic acidosis in 115 patients (evaluation group) admitted from January 2023 to March 2024. Receiver operating characteristic curve (ROC) was used to evaluate the application efficiency of the prediction model.

Results

Among 271 patients in the construction group, 130 patients developed metabolic acidosis after operation, the incidence rate was 47.97%. Among 115 patients in the evaluation group, 52 patients developed metabolic acidosis after operation, the incidence rate was 45.22%. Logistic multivariate regression analysis showed that hypoproteinemia, malnutrition/risk, operation time ≥180 min and preoperative urea nitrogen ≥7 mmol/L were independent risk factors for postoperative metabolic acidosis in patients with colorectal cancer, while body mass index≥18.5 kg/m² and rehydration speed ≥11 mL·kg^-1·h^-1 were protective factors (P＜0.05). The C-index of Nomogram model for predicting postoperative metabolic acidosis in patients with colorectal cancer was 0.862 (95% CI: 0.811-0.925), and the consistency curve of Nomogram model for predicting postoperative metabolic acidosis had a high degree of fit with the 45° diagonal line. Taking the total score ≥185 as the cutoff value, the AUC predicted by Nomogram model for postoperative metabolic acidosis in 115 patients of evaluation group was 0.851, and its sensitivity, specificity and accuracy were 88.49%, 90.48% and 89.57%, respectively.

Conclusion

The incidence of postoperative metabolic acidosis in patients with colorectal cancer is high, which is related to nutritional status, rehydration speed, operation time and glomerular filtration function. The Nomogram based on the above factors can provide more accurate reference for the prediction of postoperative metabolic acidosis in patients.

Key words: Colorectal cancer, Metabolic acidosis, Prediction model, Efficacy

Chuan Ren, Rongzhong Ge, Zhengcai Qiu, Li Zhu. Prediction model construction and application value evaluation of postoperative metabolic acidosis in patients with intestinal cancer[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2025, 15(01): 34-39.

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Figures/Tables 7

组别	例数	年龄(岁, $\bar{x}$ ±s)	病灶直径(cm, $\bar{x}$ ±s)	性别[例(%)]		病灶部位[例(%)]		TNM分期[例(%)]		病理分型[例(%)]
组别	例数	年龄(岁, $\bar{x}$ ±s)	病灶直径(cm, $\bar{x}$ ±s)	男	女	直肠	结肠	I～Ⅱ期	Ⅲ～Ⅳ期	腺癌	其他
构建组	271	62.81±7.59	4.51±0.66	165(60.89)	106(39.11)	143(52.77)	128(47.23)	181(66.79)	90(33.21)	242(89.30)	29(10.70)
评价组	115	63.06±6.93	4.48±0.53	68(59.13)	47(40.87)	63(54.78)	52(45.22)	78(67.83)	37(32.17)	104(90.43)	11(9.57)
t/χ²值		0.304	0.432	0.104		0.132		0.039		0.112
P值		0.762	0.666	0.747		0.717		0.843		0.738

组别	例数	年龄(岁, $\bar{x}$ ±s)	病灶直径(cm, $\bar{x}$ ±s)	性别[例(%)]		病灶部位[例(%)]		TNM分期[例(%)]		病理分型[例(%)]
组别	例数	年龄(岁, $\bar{x}$ ±s)	病灶直径(cm, $\bar{x}$ ±s)	男	女	直肠	结肠	I～Ⅱ期	Ⅲ～Ⅳ期	腺癌	其他
构建组	271	62.81±7.59	4.51±0.66	165(60.89)	106(39.11)	143(52.77)	128(47.23)	181(66.79)	90(33.21)	242(89.30)	29(10.70)
评价组	115	63.06±6.93	4.48±0.53	68(59.13)	47(40.87)	63(54.78)	52(45.22)	78(67.83)	37(32.17)	104(90.43)	11(9.57)
t/χ²值		0.304	0.432	0.104		0.132		0.039		0.112
P值		0.762	0.666	0.747		0.717		0.843		0.738

组别	例数	年龄[例(%)]		性别[例(%)]		病灶部位[例(%)]		TNM分期[例(%)]
组别	例数	＜60岁(n=108)	≥60岁(n=163)	男(n=165)	女(n=106)	直肠(n=143)	结肠(n=128)	I～Ⅱ期(n=181)	Ⅲ～Ⅳ期(n=90)
发生组	130	48(36.92)	82(63.08)	81(62.31)	49(37.69)	70(53.85)	60(46.15)	82(63.08)	48(36.92)
未发生组	141	60(42.55)	81(57.45)	84(59.57)	57(40.43)	73(51.77)	68(48.23)	99(70.21)	42(29.79)
t/χ²值		0.894		0.212		0.117		1.553
P值		0.344		0.645		0.733		0.213
组别	例数	病理分型[例(%)]		BMI[例(%)]		合并症[例(%)]
组别	例数	腺癌(n=242)	其他(n=29)	＜18.5kg/m²(n=154)	≥18.5kg/m²(n=117)	高血压(n=73)	糖尿病(n=44)	高脂血症(n=35)	低蛋白血症(n=28)
发生组	130	114(87.69)	16(12.31)	95(73.08)	35(26.92)	37(28.46)	31(23.85)	19(14.62)	23(17.69)
未发生组	141	128(90.78)	13(9.22)	59(41.84)	82(58.16)	36(25.53)	13(9.22)	16(11.35)	5(3.55)
t/χ²值		0.675		26.894		0.295	10.64	0.642	14.61
P值		0.411		＜0.001		0.587	0.001	0.423	＜0.001
组别	例数	营养状态[例(%)]		手术方式[例(%)]		手术情况( $\bar{x}$ ±s)
组别	例数	营养正常(n=91)	营养不良/风险(n=180)	腹腔镜(n=77)	开腹(n=194)	手术时间(min)	术中出血量(mL)
发生组	130	17(13.08)	113(86.92)	38(29.23)	92(70.77)	198.85±27.14	95.81±11.47
未发生组	141	74(52.48)	67(47.52)	39(27.66)	102(72.34)	172.63±32.31	97.96±12.05
t/χ²值		47.09		0.082		8.188	1.659
P值		＜0.001		0.774		＜0.001	0.098
组别	例数	术中补液( $\bar{x}$ ±s)		实验室指标( $\bar{x}$ ±s)
组别	例数	总补液量(mL)	补液速度(mL·kg^-1·h^-1)	尿素氮(mmol/L)	乳酸(mmol/L)	碳酸氢盐(mmol/L)
发生组	130	2011.95±583.58	10.25±1.79	8.15±1.26	1.38±0.21	25.81±2.69
未发生组	141	2026.87±601.49	12.23±2.08	6.38±1.14	1.35±0.19	26.03±2.57
t/χ²值		0.228	9.46	12.977	1.32	0.745
P值		0.82	＜0.001	＜0.001	0.188	0.457

组别	例数	年龄[例(%)]		性别[例(%)]		病灶部位[例(%)]		TNM分期[例(%)]
组别	例数	＜60岁(n=108)	≥60岁(n=163)	男(n=165)	女(n=106)	直肠(n=143)	结肠(n=128)	I～Ⅱ期(n=181)	Ⅲ～Ⅳ期(n=90)
发生组	130	48(36.92)	82(63.08)	81(62.31)	49(37.69)	70(53.85)	60(46.15)	82(63.08)	48(36.92)
未发生组	141	60(42.55)	81(57.45)	84(59.57)	57(40.43)	73(51.77)	68(48.23)	99(70.21)	42(29.79)
t/χ²值		0.894		0.212		0.117		1.553
P值		0.344		0.645		0.733		0.213
组别	例数	病理分型[例(%)]		BMI[例(%)]		合并症[例(%)]
组别	例数	腺癌(n=242)	其他(n=29)	＜18.5kg/m²(n=154)	≥18.5kg/m²(n=117)	高血压(n=73)	糖尿病(n=44)	高脂血症(n=35)	低蛋白血症(n=28)
发生组	130	114(87.69)	16(12.31)	95(73.08)	35(26.92)	37(28.46)	31(23.85)	19(14.62)	23(17.69)
未发生组	141	128(90.78)	13(9.22)	59(41.84)	82(58.16)	36(25.53)	13(9.22)	16(11.35)	5(3.55)
t/χ²值		0.675		26.894		0.295	10.64	0.642	14.61
P值		0.411		＜0.001		0.587	0.001	0.423	＜0.001
组别	例数	营养状态[例(%)]		手术方式[例(%)]		手术情况( $\bar{x}$ ±s)
组别	例数	营养正常(n=91)	营养不良/风险(n=180)	腹腔镜(n=77)	开腹(n=194)	手术时间(min)	术中出血量(mL)
发生组	130	17(13.08)	113(86.92)	38(29.23)	92(70.77)	198.85±27.14	95.81±11.47
未发生组	141	74(52.48)	67(47.52)	39(27.66)	102(72.34)	172.63±32.31	97.96±12.05
t/χ²值		47.09		0.082		8.188	1.659
P值		＜0.001		0.774		＜0.001	0.098
组别	例数	术中补液( $\bar{x}$ ±s)		实验室指标( $\bar{x}$ ±s)
组别	例数	总补液量(mL)	补液速度(mL·kg^-1·h^-1)	尿素氮(mmol/L)	乳酸(mmol/L)	碳酸氢盐(mmol/L)
发生组	130	2011.95±583.58	10.25±1.79	8.15±1.26	1.38±0.21	25.81±2.69
未发生组	141	2026.87±601.49	12.23±2.08	6.38±1.14	1.35±0.19	26.03±2.57
t/χ²值		0.228	9.46	12.977	1.32	0.745
P值		0.82	＜0.001	＜0.001	0.188	0.457

变量名	变量	变量赋值
Y	代谢性酸中毒	未发生=0,发生=1
X1	BMI	＜18.5kg/m²=0,≥18.5kg/m²=1
X2	合并低蛋白血症	无=0,有=1
X3	营养状态	营养正常=0,营养不良/风险=1
X4	手术时间	＜180min=0,≥180min=1
X5	补液速度	＜11mL·kg^-1·h^-1=0, ≥11mL·kg^-1·h^-1=1
X6	术前尿素氮	＜7mmol/L=0,≥7mmol/L=1

影响因素	β	SE(β)	Wald χ ²值	P值	OR	95%CI
BMI≥18.5kg/m²	-0.532	0.226	5.541	＜0.001	0.587	0.377～0.915
合并低蛋白血症	3.817	1.122	11.573	＜0.001	45.468	5.042～409.985
营养不良/风险	4.471	0.985	20.603	＜0.001	87.444	12.685～602.809
手术时间≥180min	0.017	0.003	32.111	0.022	1.017	1.011～1.023
补液速度≥11mL·kg^-1·h^-1	-0.952	0.229	17.282	0.003	0.386	0.246～0.605
术前尿素氮≥7mmol/L	0.625	0.119	27.585	0.009	1.868	1.480～2.359

临床诊断	模型预测
临床诊断	代谢性酸中毒高风险	代谢性酸中毒低风险	合计
代谢性酸中毒	46	6	52
未发生代谢性酸中毒	6	57	63
合计	52	63	115

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