Wu YL, Jing YL, Liu WH, Gong XY, Che L, Xue JY, Li TY, Jiang L, Huang XY, Yu WL, Weng YQ. Nomogram for predicting myocardial injury in pediatric patients undergoing living donor liver transplantation for biliary atresia. World J Gastrointest Surg 2025; 17(4): 103263 [DOI: 10.4240/wjgs.v17.i4.103263]
Corresponding Author of This Article
Yi-Qi Weng, PhD, Chief Physician, Professor, Department of Anesthesiology, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. wyq2023@nankai.edu.cn
Research Domain of This Article
Anesthesiology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Apr 27, 2025; 17(4): 103263 Published online Apr 27, 2025. doi: 10.4240/wjgs.v17.i4.103263
Nomogram for predicting myocardial injury in pediatric patients undergoing living donor liver transplantation for biliary atresia
Yu-Li Wu, Yong-Le Jing, Wei-Hua Liu, Xin-Yuan Gong, Lu Che, Jing-Yi Xue, Tian-Ying Li, Lei Jiang, Xiao-Yu Huang, Wen-Li Yu, Yi-Qi Weng
Yu-Li Wu, Wei-Hua Liu, Lu Che, Xiao-Yu Huang, Wen-Li Yu, Yi-Qi Weng, Department of Anesthesiology, Tianjin First Central Hospital, Tianjin 300192, China
Yong-Le Jing, Department of Cardiology, Tianjin First Central Hospital, Tianjin 300192, China
Xin-Yuan Gong, Department of Science and Education, Tianjin First Central Hospital, Tianjin 300192, China
Jing-Yi Xue, Tian-Ying Li, Lei Jiang, School of Medicine, Nankai University, Tianjin 300071, China
Author contributions: Wu YL, Jing YL, and Weng YQ conceived the manuscript; Liu WH and Che L wrote and prepared the tables and figures; Gong XY reviewed the statistical methods; Xue JY and Li TY coordinated and supervised data collection; Jiang L and Huang XY performed the statistical analysis; Yu WL and Weng YQ critically reviewed the manuscript for important intellectual content. Yu WL and Weng YQ contributed equally to this manuscript. All authors have read and agreed to the published version of the manuscript.
Supported by Tianjin Health Research Project, No. TJWJ2024QN037; Research Empowerment-Medical Research and Application Fund Project, No. BHCF-KYFN-2024004; and the Young Talent Program of Tianjin First Central Hospital.
Institutional review board statement: This research received approval from the ethics committee of Tianjin First Central Hospital, No. 2022DZX02.
Informed consent statement: Since this was a retrospective study with the inability to access to the patients, the Ethics Committee granted a waiver for the requirement of informed consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Qi Weng, PhD, Chief Physician, Professor, Department of Anesthesiology, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. wyq2023@nankai.edu.cn
Received: November 21, 2024 Revised: December 28, 2024 Accepted: February 27, 2025 Published online: April 27, 2025 Processing time: 128 Days and 15.6 Hours
Abstract
BACKGROUND
Myocardial injury is common during liver transplantation and is associated with poor outcomes. The development of a reliable prediction system for this type of injury is crucial for reducing the incidence of cardiac complications in children receiving living donor liver transplantation (LDLT). However, establishing a practical myocardial injury prediction system for children with biliary atresia remains a considerable challenge.
AIM
To create and validate a nomogram model for predicting myocardial injury in children with biliary atresia who received LDLT.
METHODS
Clinical data from pediatric patients who received LDLT for biliary atresia between November, 2019 and January, 2022 were retrospectively analyzed. The complete dataset was randomly partitioned into a training set and a validation set at a ratio of 7:3. Least absolute shrinkage and selection operator regression was used to preliminarily screen out the predictors of myocardial injury. The prediction model was established via multivariable logistic regression and presented in the form of a nomogram.
RESULTS
This study included 321 patients, 150 (46.7%) of whom had myocardial injury. The participants were randomly allocated into two groups: A training group consisting of 225 patients and a validation group comprising 96 patients. The predictors in this nomogram included the preoperative neutrophil-to-lymphocyte ratio, high sensitivity C-reactive protein level, pediatric end-stage liver disease score and postreperfusion syndrome. The area under the curve for predicting myocardial injury was 0.865 in the training set and 0.856 in the validation set. The calibration curve revealed that the predicted values were very close to the actual values in the two sets. Decision curve analysis revealed that the prediction model offered a favorable net benefit.
CONCLUSION
The nomogram developed in this study effectively predicts myocardial injury in pediatric LDLT patients, showing good accuracy and potential for clinical application.
Core Tip: Myocardial injury is common during liver transplantation and is associated with a poor prognosis. Clinical data from pediatric patients who underwent living donor liver transplantation for biliary atresia were retrospectively analyzed. The prediction model was established via multivariable logistic regression and presented in the form of a nomogram. The predictors in this nomogram included the preoperative neutrophil-to-lymphocyte ratio, high sensitivity C-reactive protein level, pediatric end-stage liver disease score and postreperfusion syndrome. This nomogram effectively predicts myocardial injury during pediatric living donor liver transplantation, demonstrating strong discrimination, accuracy, and promising potential for clinical application.
