Development and validation of a nomogram for predicting prolonged ICU stays after pediatric cardiac surgery

doi:10.5847/wjem.j.1920-8642.2025.039

Abstract

Abstract:

BACKGROUND: This study aimed to develop and validate a nomogram to estimate the probability of prolonged intensive care unit (ICU) stays.

METHODS: Pediatric patients who underwent cardiac surgery were included, with data collected from the pediatric intensive care database. The datasets were randomly divided into a training set (75%) and a testing set (25%). A nomogram model was developed to predict prolonged ICU stays in the training set and then validated in the testing set.

RESULTS: A total of 795 patients and 266 patients were assigned to the training and testing sets, respectively, with consistent variables. The nomogram developed from the training set included eight characteristics: age, systolic blood pressure, respiratory rate, bicarbonate, direct bilirubin, high-sensitivity C-reactive protein, international normalized ratio, and operation time. The area under the curve values of the nomogram in the training and testing sets were 0.812 and 0.736, respectively. The nomogram demonstrated excellent discrimination and calibration. Decision curve analysis showed that the use of the nomogram resulted in more favorable outcomes compared with the strategies of treating all or none of the patients.

CONCLUSION: This study presents a nomogram that may enable early identification of high-risk patients and facilitates tailored postoperative care and better outcomes after pediatric cardiac surgery.

Key words: Pediatric, Cardiac surgery, Prolonged ICU stays, Nomogram

Jungang Zheng, Wenyuan Zhang, Yuqian Guo, Huiyi Hu, Yue Jin, Xiangming Fang. Development and validation of a nomogram for predicting prolonged ICU stays after pediatric cardiac surgery[J]. World Journal of Emergency Medicine, 2025, 16(5): 456-461.

Figures/Tables 3

Table 1.

Table 2.

Figure 1.

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Parameters	All patients (n=795)	Non-prolonged stay in the ICU group (n=598)	Prolonged stay in the ICU group (n=197)	P-value
Age, years	1.78 (0.86-3.90)	2.32 (1.23-4.56)	0.61 (0.35-1.53)	<0.001
Male, n (%)	358 (45.0)	270 (45.2)	88 (44.7)	0.972
Operation time, min	109 (71-129)	103 (52-123)	125 (112-141)	<0.001
HR, beats/min	128 (109-143)	124 (105-138)	138 (121-154)	<0.001
RR, beats/min	27 (24-30)	28 (24-30)	27 (25-30)	0.038
Temperature, °C	36.8 (36.2-37.3)	36.8 (36.3-37.3)	36.7 (36.1-37.2)	0.006
DBP, mmHg	60 (52-67)	61 (54-68)	55 (47-63)	<0.001
SBP, mmHg	103 (95-112)	105 (96-112)	100 (89-108)	<0.001
RBC, ×10⁹/L	3.83±0.53	3.89±0.53	3.63±0.48	<0.001
HBG, g/L	104.92±13.92	106.12±13.99	101.26±13.07	<0.001
WBC, ×10⁹/L	9.84 (7.08-13.10)	10.00 (7.37-13.60)	9.19 (6.58-12.10)	0.009
Neutrophil, ×10⁹/L	6.79 (4.58-10.00)	6.96 (4.71-10.50)	6.29 (4.25-8.75)	0.005
Hs-CRP, mg/L	43.00 (19.96-67.40)	39.00 (10.14-63.96)	53.00 (34.76-75.00)	<0.001
PLT, ×10⁹/L	205.0 (157.5-267.0)	223.0 (170.3-285.3)	168.0 (141.0-206.0)	<0.001
INR	1.22±0.17	1.18±0.15	1.33±0.17	<0.001
Fib, g/L	2.52 (2.07-3.16)	2.61 (2.14-3.24)	2.27 (1.82-2.98)	<0.001
ALB, g/L	40.2 (37.7-42.6)	40.3 (38.0-42.7)	39.4 (36.4-42.1)	0.003
Glu, mmol/L	8.5 (6.4-10.5)	7.7 (6.1-9.9)	10.0 (8.4-12.0)	<0.001
BNP, pg/mL	2161.0 (661.5-4438.5)	1611.0 (439.3-3124.8)	4756.0 (2542.0-9690.0)	<0.001
Lac, mmol/L	1.8 (1.3-2.4)	1.7 (1.3-2.3)	2.0 (1.5-2.6)	<0.001
Bicarbonate, mmol/L	22.8 (21.6-24.1)	22.7 (21.4-23.9)	23.2 (22.1-24.6)	<0.001
Direct bilirubin, μmol/L	12.0 (9.2-16.7)	11.2 (8.7-14.9)	15.8 (11.3-24.7)	<0.001
Cr, μmol/L	39 (33-45)	40 (33-46)	39 (33-43)	0.121
Sodium, mmol/L	140 (138-142)	140 (138-142)	140 (138-142)	0.617
Potassium, mmol/L	3.4 (3.1-3.7)	3.4 (3.1-3.7)	3.3 (3.1-3.6)	0.402

Parameters	β	SE	Wald	P	OR (95% CI)
Age, years	-0.256	0.067	14.775	<0.001	0.77 (0.67-0.88)
SBP, mmHg	-0.024	0.009	8.203	0.004	0.98 (0.96-0.99)
RR, beats/min	-0.086	0.023	13.318	<0.001	0.92 (0.86-0.96)
Bicarbonate, mmol/L	0.158	0.056	8.057	0.001	1.17 (1.05-1.31)
Direct bilirubin, μmol/L	0.024	0.011	5.203	0.023	1.02 (1.00-1.05)
Hs-CRP, mg/L	0.010	0.003	8.332	0.004	1.01 (1.00-1.02)
INR	2.273	0.786	8.360	0.004	9.71 (2.02-44.52)
Operation time, min	0.015	0.003	20.258	<0.001	1.02 (1.01-1.02)

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