Analysis of the influencing factors of severe acute pancreatitis complicated with intra-abdominal hypertension and construction of the nomogram prediction model

Ji Deyu; Qian Jiajun; Song Zhi; Yang Gongli

doi:10.3760/j.issn.1673-4777.2025.09.013

Abstract：Objective To analyze the influencing factors of intra-abdominal hypertension(IAH)in patients with severe acute pancreatitis(SAP),and to construct a nomogram model based on these factors,and to evaluate the predictive efficacy of the nomogram model.Methods The clinical data of 160 SAP patients admitted to the Department of Critical Care Medicine,Shenzhen University General Hospital and Intensive Care Unit,Nansha Hospital,Guangzhou First People's Hospital,Guangdong Province from February 2022 to June 2024 were retrospectively analyzed.According to the presence or absence of IAH during hospitalization,SAP patients with IAH were included in the occurrence group(82 cases),and SAP patients without IAH were included in the non-occurrence group(78 cases).The clinical data of the two groups within 24 hours after admission were compared.Logistic regression analysis was used to screen the risk factors of SAP patients with IAH.A nomogram model was constructed,and the receiver operating characteristic curve,Hosmer-Lemeshow test,and decision analysis curve were used to evaluate the discrimination,calibration,and clinical benefits of the nomogram model.Results There were significant differences in body mass index(BMI),acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,24 h fluid load,positive end-expiratory pressure,procalcitonin and C-reactive protein levels between the two groups(all P＜0.05).Logistic regression analysis showed that,BMI(odds ratio=1.122),APACHE Ⅱ score(odds ratio=1.342),24 h fluid load(odds ratio=1.229),positive end-expiratory pressure(odds ratio=1.224),procalcitonin(odds ratio=1.164)and C-reactive protein(odds ratio=1.182)were all risk factors for IAH in SAP patients(all P＜0.05).A risk nomogram model for SAP patients with IAH was constructed based on BMI,APACHE Ⅱ score,24 h fluid load,positive end-expiratory pressure,procalcitonin and C-reactive protein.Hosmer-Lemeshow test results showed that there was no significant difference between the predicted value of the nomogram model and the actual value(x2=2.015,P=0.377).The results of receiver operating characteristic curve analysis showed that the sensitivity,specificity,and area under the curve of the nomogram model for predicting SAP patients with IAH were 89.9％,74.8％,and 0.885,respectively.The results of decision curve analysis showed that the nomogram model had high predictive value and clinical validity.Conclusions The nomogram model based on BMI,APACHE Ⅱ score,24 h fluid load,positive end-expiratory pressure,procalcitonin and C-reactive protein has a good predictive efficacy for SAP patients complicated with IAH.