Development and Validation of a Nomogram Incorporating Colloid Osmotic Pressure for Predicting Mortality in Critically Ill Neurological Patients

Bo Lv; Linhui Hu; Heng Fang; Dayong Sun; Yating Hou; Jia Deng; Huidan Zhang; Jing Xu; Linling He; Yufan Liang; Chunbo Chen

doi:10.3389/fmed.2021.765818

Development and Validation of a Nomogram Incorporating Colloid Osmotic Pressure for Predicting Mortality in Critically Ill Neurological Patients

Front Med (Lausanne). 2021 Dec 24:8:765818. doi: 10.3389/fmed.2021.765818. eCollection 2021.

Authors

Bo Lv^{1

2

3}, Linhui Hu^{4

5}, Heng Fang^{1

4}, Dayong Sun⁶, Yating Hou^{3

7}, Jia Deng¹, Huidan Zhang¹, Jing Xu¹, Linling He¹, Yufan Liang¹, Chunbo Chen^{1

2

8}

Affiliations

¹ Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
³ Department of General Practice, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁴ Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China.
⁵ Department of Clinical Research Center, Maoming People's Hospital, Maoming, China.
⁶ Department of Emergency, Longgang District Central Hospital, Shenzhen, China.
⁷ Department of Oncology, Maoming People's Hospital, Maoming, China.
⁸ Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

Abstract

Backgrounds: The plasma colloid osmotic pressure (COP) values for predicting mortality are not well-estimated. A user-friendly nomogram could predict mortality by incorporating clinical factors and scoring systems to facilitate physicians modify decision-making when caring for patients with serious neurological conditions. Methods: Patients were prospectively recruited from March 2017 to September 2018 from a tertiary hospital to establish the development cohort for the internal test of the nomogram, while patients recruited from October 2018 to June 2019 from another tertiary hospital prospectively constituted the validation cohort for the external validation of the nomogram. A multivariate logistic regression analysis was performed in the development cohort using a backward stepwise method to determine the best-fit model for the nomogram. The nomogram was subsequently validated in an independent external validation cohort for discrimination and calibration. A decision-curve analysis was also performed to evaluate the net benefit of the insertion decision using the nomogram. Results: A total of 280 patients were enrolled in the development cohort, of whom 42 (15.0%) died, whereas 237 patients were enrolled in the validation cohort, of which 43 (18.1%) died. COP, neurological pathogenesis and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were predictors in the prediction nomogram. The derived cohort demonstrated good discriminative ability, and the area under the receiver operating characteristic curve (AUC) was 0.895 [95% confidence interval (CI), 0.840-0.951], showing good correction ability. The application of this nomogram to the validation cohort also provided good discrimination, with an AUC of 0.934 (95% CI, 0.892-0.976) and good calibration. The decision-curve analysis of this nomogram showed a better net benefit. Conclusions : A prediction nomogram incorporating COP, neurological pathogenesis and APACHE II score could be convenient in predicting mortality for critically ill neurological patients.

Keywords: colloid osmotic pressure; critically ill neurological patients; mortality; nomogram; predicting.