Objectives: To generate a prognostic model based on a nomogram for adverse event (AE) prediction after lumen-apposing metal stents (LAMS) placement in patients with pancreatic fluid collections (PFC). Methods: Data from a large multicenter series of PFCs treated with LAMS placement were retrieved. AE (overall and excluding mild events) prediction was calculated through a logistic regression model and a nomogram was created and internally validated after bootstrapping. Results were expressed in terms of odds ratio (OR) and 95% confidence interval (CI). Discrimination was assessed by c-statistics and calibrated by comparing deciles of predicted and observed ORs. Results: Overall, 516 patients were included (males 68%, mean age 61.6 ± 15.2 years). PFCs were predominantly walled-off necrosis (52.1%). Independent predictors of AE occurrence were injury of main pancreatic duct (OR in the case of leak 2.51, 95% CI 1.06–5.97, P = 0.03; OR in the case of complete disruption 2.61, 1.53–4.45, P = 0.01), abnormal vessels (OR in the case of perigastric varices 2.90, 1.31–6.42, P = 0.008; OR in the case of pseudoaneurysm 2.99, 1.75–11.93, P = 0.002), using a multigate technique (OR 3.00, 1.28–5.24; P = 0.05), and need of percutaneous drainage (OR 2.81, 1.03–7.65, P = 0.04). By nomogram, a score beyond 200 points corresponded to a 50% probability of AE occurrence. The model was confirmed even when excluding mild AEs and it showed optimal discrimination (c-index 76.8%, 95% CI 74–79), confirmed after internal validation. Conclusion: Patients with preprocedural evidence of pancreatic duct leak/disruption, vessel alteration, requiring percutaneous drainage or a multigate technique are at higher risk for AE.
Nomogram for prediction of adverse events after lumen-apposing metal stent placement for drainage of pancreatic fluid collections / Facciorusso A.; Amato A.; Crino S.F.; Sinagra E.; Maida M.; Fugazza A.; Binda C.; Repici A.; Tarantino I.; Anderloni A.; Fabbri C.; Ramai D.; Forti E.; Petrone M.C.; Di Mitri R.; Berretti D.; De Nucci G.; Macchiarelli R.; Lovera M.; Attili F.; Brancaccio M.L.; Redaelli A.; Tasini E.; Ballare M.; Coppola F.; Leone N.; Cugia L.; Grassia R.; Sbrancia M.; Togliani T.; Fusaroli P.; De Angelis C.; Cipolletta F.; Manno M.; Badas R.; Pollino V.; Camellini L.; Bernardoni L.; Conte E.; Lisotti A.; Mutignani M.; Arcidiacono P.G.. - In: DIGESTIVE ENDOSCOPY. - ISSN 0915-5635. - STAMPA. - 34:7(2022), pp. 1459-1470. [10.1111/den.14354]
Nomogram for prediction of adverse events after lumen-apposing metal stent placement for drainage of pancreatic fluid collections
Facciorusso A.;Maida M.;Fugazza A.;Binda C.;Tarantino I.;Attili F.;Redaelli A.;Grassia R.;Fusaroli P.;Manno M.;Lisotti A.;
2022
Abstract
Objectives: To generate a prognostic model based on a nomogram for adverse event (AE) prediction after lumen-apposing metal stents (LAMS) placement in patients with pancreatic fluid collections (PFC). Methods: Data from a large multicenter series of PFCs treated with LAMS placement were retrieved. AE (overall and excluding mild events) prediction was calculated through a logistic regression model and a nomogram was created and internally validated after bootstrapping. Results were expressed in terms of odds ratio (OR) and 95% confidence interval (CI). Discrimination was assessed by c-statistics and calibrated by comparing deciles of predicted and observed ORs. Results: Overall, 516 patients were included (males 68%, mean age 61.6 ± 15.2 years). PFCs were predominantly walled-off necrosis (52.1%). Independent predictors of AE occurrence were injury of main pancreatic duct (OR in the case of leak 2.51, 95% CI 1.06–5.97, P = 0.03; OR in the case of complete disruption 2.61, 1.53–4.45, P = 0.01), abnormal vessels (OR in the case of perigastric varices 2.90, 1.31–6.42, P = 0.008; OR in the case of pseudoaneurysm 2.99, 1.75–11.93, P = 0.002), using a multigate technique (OR 3.00, 1.28–5.24; P = 0.05), and need of percutaneous drainage (OR 2.81, 1.03–7.65, P = 0.04). By nomogram, a score beyond 200 points corresponded to a 50% probability of AE occurrence. The model was confirmed even when excluding mild AEs and it showed optimal discrimination (c-index 76.8%, 95% CI 74–79), confirmed after internal validation. Conclusion: Patients with preprocedural evidence of pancreatic duct leak/disruption, vessel alteration, requiring percutaneous drainage or a multigate technique are at higher risk for AE.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
