急性胰腺炎患儿肠内营养喂养不耐受的因素分析及风险预测模型的建立OACSTPCD

Objective To establish a risk prediction model for enteral nutrition feeding intolerance(ENFI)in chil-dren with acute pancreatitis(AP)by analyzing the influencing factors.Methods A purposive sampling method was used to collect 401 children with acute pancreatitis admitted to Department of Gastroenterology,Children's Hospital Affiliated to Nanjing Medical University from June 2017 to June 2020 as the research subjects.They were divided into 280 cases in mod-eling groups and 121 cases in validation groups using a random number table method.The modeling group was separated into ENFI subgroup(n=113)and non-ENFI subgroup(n=167)based on whether ENFI occurred.Clinicaldata were collected,univariate and multivariate Logistic regression were applied to analyze the influencing factors of ENFI in children with AP;R software was applied to construct a column chart model for predicting ENFI in children with AP,and the predictive perform-ance of the model was evaluated.Results The proportions of infants with IAP≤20 cmH2 O,APACHEⅡscore≤20,serum Alb level>25 g/L,enteralnutrition start time≤72 h,and CVP≤12 cmH2 O in the ENFI subgroup were lower than those in the non-ENFI subgroup(χ2/P=8.450/0.004,7.453/0.006,8.717/0.003,8.551/0.003,6.771/0.009),while the proportion of no addi-tion of soluble fiber was higher than non-ENFI subgroup(χ2/P= 7.448/0.006);multivariate Logistic regression analysis showed that abdominal pressure>20 cmH2O,no addition of soluble fiber,serum Alb level≤25 g/L,enteral nutrition start time>72 hours,and centralvenous pressure>12 cmH2O were independent risk factors for ENFI in AP children[OR(95%CI)= 2.111(1.139-3.913),2.019(1.036-3.935),1.989(1.081-3.660),1.907(1.032-3.524),2.112(1.170-3.812)];the validation re-sults of the modeling group showed that the area under the ROC curve(AUC)was 0.886(95%CI0.850-0.922),indicated good consistency between the predicted risk of ENFI in AP patients and the actual risk.The AUC for external validation was 0.890(95%CI0.853-0.926),and the model predicted a good consistency between the risk of ENFI in AP patients and the actual risk(χ2=6.130,P=0.419).Conclusion Abdominal pressure>20 cmH2 O,no addition of soluble fiber,serum Alb level≤25 g/L,enteralnutrition start time>72 hours,and centralvenous pressure>12 cmH2 O are independent risk factors affecting the occurrence of ENFI in children with AP.The prediction model constructed based on this has good predictive value and can provide reference for early prediction of the risk of ENFI in children with AP.