TY  - JOUR
TI  - Development and internal validation of clinical prediction models for outcomes of complicated intra-abdominal infection
Y1  - 2021/04//
N1  - This version is the author accepted manuscript. For information on re-use, please refer to the publisher?s terms and conditions.
PB  - OXFORD UNIV PRESS
ID  - discovery10184148
VL  - 108
UR  - https://doi.org/10.1093/bjs/znaa117
A1  - Ahmed, S
A1  - Bonnett, L
A1  - Melhuish, A
A1  - Adil, MT
A1  - Aggarwal, I
A1  - Ali, W
A1  - Bennett, J
A1  - Boldock, E
A1  - Burns, FA
A1  - Czarniak, E
A1  - Dennis, R
A1  - Flower, B
A1  - Fok, R
A1  - Goodman, AL
A1  - Halai, S
A1  - Hanna, T
A1  - Hashem, M
A1  - Hodgson, SH
A1  - Hughes, G
A1  - Hurndall, K-H
A1  - Hyland, R
A1  - Iqbal, MR
A1  - Jarchow-MacDonald, A
A1  - Kailavasan, M
A1  - Klimovskij, M
A1  - Laliotis, A
A1  - Lambourne, J
A1  - Lawday, S
A1  - Lee, F
A1  - Lindsey, B
A1  - Lund, JN
A1  - Mabayoje, DA
A1  - Malik, K
A1  - Muir, A
A1  - Narula, HS
A1  - Ofor, U
A1  - Parsons, H
A1  - Pavelle, T
A1  - Prescott, K
A1  - Rajgopal, A
A1  - Roy, I
A1  - Sagar, J
A1  - Scarborough, C
A1  - Shaikh, S
A1  - Smart, CJ
A1  - Snape, S
A1  - Tabaqchali, MA
A1  - Tennakoon, A
A1  - Tilley, R
A1  - Vink, E
A1  - White, L
A1  - Burke, D
A1  - Kirby, A
EP  - 447
N2  - Background:
Complicated intra-abdominal infections (cIAIs) are associated with significant morbidity and mortality. The aim of this study was to describe the clinical characteristics of patients with cIAI in a multicentre study and to develop clinical prediction models (CPMs) to help identify patients at risk of mortality or relapse.

Methods:
A multicentre observational study was conducted from August 2016 to February 2017 in the UK. Adult patients diagnosed with cIAI were included. Multivariable logistic regression was performed to develop CPMs for mortality and cIAI relapse. The c-statistic was used to test model discrimination. Model calibration was tested using calibration slopes and calibration in the large (CITL). The CPMs were then presented as point scoring systems and validated further.

Results:
Overall, 417 patients from 31 surgical centres were included in the analysis. At 90 days after diagnosis, 17.3 per cent had a cIAI relapse and the mortality rate was 11.3 per cent. Predictors in the mortality model were age, cIAI aetiology, presence of a perforated viscus and source control procedure. Predictors of cIAI relapse included the presence of collections, outcome of initial management, and duration of antibiotic treatment. The c-statistic adjusted for model optimism was 0.79 (95 per cent c.i. 0.75 to 0.87) and 0.74 (0.73 to 0.85) for mortality and cIAI relapse CPMs. Adjusted calibration slopes were 0.88 (95 per cent c.i. 0.76 to 0.90) for the mortality model and 0.91 (0.88 to 0.94) for the relapse model; CITL was ?0.19 (95 per cent c.i. ?0.39 to ?0.12) and ? 0.01 (? 0.17 to ?0.03) respectively.

Conclusion:
Relapse of infection and death after complicated intra-abdominal infections are common. Clinical prediction models were developed to identify patients at increased risk of relapse or death after treatment, these now require external validation.
SN  - 0007-1323
SP  - 441
KW  - Science & Technology
KW  -  Life Sciences & Biomedicine
KW  -  Surgery
KW  -  MULTIPLE IMPUTATION
KW  -  DIAGNOSIS
KW  -  MORTALITY
KW  -  TRIAL
IS  - 4
AV  - public
JF  - British Journal of Surgery
ER  -