Li Chunming,Zhao Fangzhou,Zhao Youquan,et al.Development of a nomogram model to predict postoperative recurrence of upper urinary tract stones in children[J].Journal of Clinical Pediatric Surgery,,():18-24.[doi:10.3760/cma.j.cn101785-202205043-004]
Development of a nomogram model to predict postoperative recurrence of upper urinary tract stones in children
- Keywords:
- Child; Urinary Tract Stones; Recurrence; Independent Risk Factors; Nomogram
- Abstract:
- Objective To investigate the recurrence status of upper urinary tract stones in children,analyze the risk factors influencing stone recurrence,and establish a nomogram to predict recurrence risk. Methods A retrospective analysis was performed on clinical data from 218 pediatric patients who underwent surgical treatment for upper urinary tract stones at Beijing Friendship Hospital between June 2014 and December 2020.Univariate and multivariate Cox regression models were used to screen clinical and follow-up data.Recurrence curves were plotted using the Kaplan-Meier method.A predictive nomogram model was constructed based on identified independent risk factors,and the model’s predictive performance was evaluated. Results Among the 218 patients,157 were male and 61 were female,with a mean age of 4.1±3.4 years.The average follow-up duration was 48.3±21.8 months,and the overall recurrence rate was 16.1% (35/218).Multivariate Cox regression analysis identified four independent risk factors for stone recurrence:age above three years (HR=8.685,95%CI:1.144-65.930),obesity compared to underweight (HR=7.903,95%CI:1.046-59.684),stone density greater than 2000 Hu·cm2 compared to less than 1000 Hu·cm2 (HR=2.842,95%CI:1.171-6.895),and positive preoperative urinary leukocytes (HR=5.172,95%CI:1.681-15.913).A nomogram model was developed using these four risk factors,demonstrating excellent predictive performance with a C-index of 0.853.The area under the curve (AUC) for predicting non-recurrence at one,three,and five years was 0.98,0.96,and 0.84,respectively.Calibration curves closely aligned with ideal curves,indicating good predictive accuracy. Conclusions Pediatric upper urinary tract stones have a high postoperative recurrence rate.Higher age,obesity,large stone density and positive preoperative urinary leukocytes significantly increase recurrence risk.The nomogram model developed in this study provides clinicians with a reliable tool to identify high-risk patients and develop personalized strategies for the prevention and treatment of stone recurrence.
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Memo
收稿日期:2022-5-12。
基金项目:北京市医院管理局临床技术创新项目(XMLX201826)
通讯作者:李钧,Email:lljun@yeah.net