关键词: 直肠癌, 吻合口瘘, 重症监护病房, 列线图, 预测模型

Abstract: Objective To investigate factors associated with anastomotic leakage in patients with rectal cancer admitted to the intensive care unit （ICU） after surgery and to develop a nomogram-based risk prediction model. Methods Clinical data of postoperative patients with rectal cancer admitted to the ICU were retrospectively analyzed. Patients were grouped according to the occurrence of anastomotic leakage during the index hospitalization. Univariable and multivariable logistic regression analyses were performed to identify candidate predictors, and a nomogram was constructed. Model discrimination, calibration, and clinical utility were assessed using receiver operating characteristic curve analysis, bootstrap calibration with 1 000 resamples, and decision curve analysis, respectively. Results A total of 162 patients were included, of whom 31 developed anastomotic leakage. Age, body mass index （BMI）, vasopressor use, invasive mechanical ventilation, and continuous renal replacement therapy （CRRT） were included in the final prediction model. The model achieved an area under the receiver operating characteristic curve （AUC） of 0.863 （95% CI： 0.785-0.941）. The mean absolute error of the bootstrap-validated calibration curve was 0.024. Decision curve analysis showed that the model provided a higher net benefit across threshold probabilities ranging from 0.10 to 0.60. Conclusion The nomogram showed good discrimination and calibration and may provide a useful tool for risk stratification of anastomotic leakage in postoperative ICU patients with rectal cancer.

Key words: rectal cancer, anastomotic leakage, intensive care unit, nomogram, prediction model