Objective To explore the application value of a computed tomography (CT)⁃based nomogram in predicting the efficacy of percutaneous catheter drainage (PCD) for acute pancrea⁃titis (AP) complicated with peripancreatic fluid collections (PFCs).
Methods The retrospective cohort study was conducted. The clinical and CT data of 60 patients of AP complicated with PFCs who were admitted to The Affiliated Hospital of Guizhou Medical University from January 2023 to February 2025 were collected. There were 43 males and 17 females, aged 42(37,56)years. All 60 patients underwent PCD, among whom 33 cases with successful drainage were set as the successful drainage group, and 27 cases with failed drainage were set as the failed drainage group. Observation indicators: (1) comparison of clinical and CT imaging data between patients of the successful drainage group and failed drainage group; (2) analysis of factors influencing PCD failure; (3) construction and evaluation of the prediction model. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi‑square test or Fisher exact probability. Univariate and multivariate analyses were conducted using the Logistic regression model. A nomogram prediction model was constructed based on the results of multi-variate analysis. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficacy of the model. The calibration curve was used to assess the fitting effect, and decision curve was used to determine the clinical application value.
Results (1) Comparison of clinical and CT imaging data between patients of the successful drainage group and failed drainage group. There were significant differences in duration of hospital stay, PFCs homogeneity, PFCs volume and pancreatic necrosis volume between patients of the successful drainage group and failed drainage group (Z=2.654, χ²=10.909, 8.148, 4.949, P<0.05). There was a significant difference in pancreatic hemorrhage between patients of the successful drainage group and failed drainage group (P<0.05), and a signifi-cant difference in modified CT severity index (MCTSI) score between patients of the successful drainage group and failed drainage group (χ²=10.884, P<0.05). (2) Analysis of factors influencing PCD failure. Results of univariate analysis showed that PFCs homogeneity, PFCs volume, pancreatic necrosis volume, and MCTSI score were influencing factors for PCD failure in patients of AP complicated with PFCs (odds ratio=8.500, 4.750, 3.333, 6.250, 95% confidence interval as 2.137-33.815, 1.584-14.245, 1.134-9.801, 2.021-19.324, P<0.05). Results of multivariate analysis showed that PFCs homogeneity, PFCs volume, and MCTSI score were independent factors for PCD failure in patients of AP complicated with PFCs (odds ratio=4.818, 4.159, 4.755, 95% confidence interval as 1.023-22.700, 1.149-15.050, 1.061-21.316, P<0.05). (3) Construction and evaluation of the prediction model. The nomogram model for predicting PCD efficacy in patients of AP complicated with PFCs was constructed by incor-porating PFCs homogeneity, PFCs volume, and MCTSI score. A higher total score of the three factors indicated a higher probability of PCD failure. ROC curve analysis showed an area under the curve of 0.829 (95% confidence interval as 0.725-0.933, P<0.05), with a sensitivity of 88.9% and specificity of 66.7%. Calibration curve demonstrated good consistency between the predicted probability of the model and the actual probability. Decision curve analysis revealed that the model achieved a favor-able overall net benefit when the threshold probability was 0.4.
Conclusions PFCs homogeneity, PFCs volume, and MCTSI score are independent factors for PCD failure in patients of AP complicated with PFCs. The nomogram model constructed based on these factors can be used to predict the efficacy of PCD in patients of AP complicated with PFCs.
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