Nomogram for predicting transmural bowel infarction in patients with acute superior mesenteric venous thrombosis

Table 1 Participant characteristics

Variable	Cohort, n (%)
	Training (n = 207)	Validation (n = 89)	P value
Age, yrs	48.5 ± 13.2	51.3 ± 8.2	0.07
Gender			0.52
Male	145 (70.0)	59 (66.3)
Female	62 (30.0)	30 (33.7)
Tobacco use	40 (19.3)	25 (28.1)	0.09
Coexisting medical conditions
Hypertension	19 (9.2)	13 (14.6)	0.17
Diabetes	20 (9.7)	13 (14.6)	0.22
Ischemic heart disease	8 (3.9)	9 (10.1)	0.05
Previous history of DVT	39 (18.8)	17 (19.1)	0.81
Malignant disease	24 (2.4)	5 (5.6)	0.11
Clinical manifestations
Diarrhea	22 (10.6)	14 (15.7)	0.22
Hematochezia or melena	62 (30.0)	19 (21.3)	0.13
Fever	26 (12.6)	13 (14.6)	0.63
Physical findings
Abdominal distention	109 (52.7)	37 (41.6)	0.16
Abdominal tenderness	39 (18.8)	24 (27.0)	0.12
Rebound tenderness	38 (18.4)	21 (23.6)	0.3
Laboratory findings
White blood cells, 109/L	7.0 (4.7-11.4)	11.0 (7.5-14.4)	0.05
Hemoglobin, g/L	109 (82-122)	113 (92-130)	0.11
Platelets, 109/L	191 (100-288)	168 (133-214)	0.06
C-reactive protein, mg/L	51.3 (7.7-67.5)	53.9 (18.2-75.1)	0.23
Serum lactate levels, mmol/L	4.3 (2.7-6.5)	3.9 (1.3-5.7)	0.31
Creatinine, µmol/L	72 (60-91)	76 (65-108)	0.07
D-dimer, mg/L	16.9 (3.0-179.6)	14.1 (6.9-60.2)	0.61
Procalcitonin, µg/L	0.5 (0.4-0.6)	0.4 (0.1-1.8)	0.17
Radiologic features
Distal thrombosis	63 (30.4)	25 (28.1%)	0.69
Portal vein or/and splenic vein extension	143 (69.1)	54 (60.7)	0.16
Decreased bowel wall enhancement	70 (33.8)	36 (40.4)	0.28
Bowel wall thickening	42 (21.3)	19 (21.3)	0.84
Bowel loop dilation	41 (19.8)	16 (18.0)	0.71
Pneumatosis intestinalis	52 (25.1)	27 (30.3)	0.13
Ascites	91 (44.0)	31 (34.8)	0.14
Other risk factors
Recent surgery	46 (22.2)	15 (16.9)	0.3
Intraperitoneal inflammation	73 (35.3)	31 (34.8)	0.94
Liver cirrhosis	82 (39.6)	37 (41.6)	0.75

Data are median (IQR) or n (%). P values were calculated by Mann-Whitney U test, t test, χ² test, or Fisher’s exact test, as appropriate. DVT: Deep venous thrombosis.

Table 2 Univariate analysis of risk factors associated with transmural bowel infarction in the training cohort

Variable	OR (95%CI)	P value
Age, yr	0.97 (0.95-0.99)	0.01
Gender, male vs female	2.22 (1.06-4.65)	0.03
Tobacco use	1.03 (0.48-2.23)	0.94
Hypertension	1.10 (0.38-3.20)	0.86
Diabetes	3.85 (0.86-17.14)	0.08
Ischemic heart disease	2.81 (0.34-23.36)	0.34
Previous history of DVT	3.14 (1.53-6.47)	0.002
Malignant disease	0.41 (0.21-1.78)	0.99
Diarrhea	1.04 (0.39-2.81)	0.93
Hematochezia	2.53 (1.33-4.79)	0.004
Fever	1.16 (0.47-2.83)	0.75
Abdominal distention	3.56 (1.82-6.97)	< 0.001
Abdominal tenderness	7.25 (3.40-15.46)	< 0.001
Rebound tenderness	9.14 (4.17-20.04)	< 0.001
White blood cells, > 10 × 109/L vs ≤ 10 × 109/L	1.12 (1.06-1.17)	< 0.001
Hemoglobin, > 120 g/L vs ≤ 120 g/L	1.01 (1.00-1.02)	0.35
Platelets, > 100 × 109/L vs ≤ 100 × 109/L	1.00 (0.99-1.01)	0.96
C-reactive protein, > 50 mg/L vs ≤ 50 mg/L	1.02 (1.01-1.02)	0.05
Serum lactate levels, > 2 mmol/L vs ≤ 2 mmol/L	6.53 (3.27-13.04)	< 0.001
Creatinine, > 106 µmol/L vs ≤ 106 µmol/L	2.05 (0.96-4.41)	0.07
D-dimer, > 0.5 mg/L vs ≤ 0.5 mg/L	1.00 (1.00-1.01)	0.50
Procalcitonin, > 0.5 µg/L vs ≤ 0.5 µg/L	1.02 (0.92-1.12)	0.72
Distal thrombosis	2.13 (1.07-4.36)	0.02
Portal vein or/and splenic vein extension	1.01 (0.52-1.94)	0.98
Decreased bowel wall enhancement	9.00 (4.24-19.12)	< 0.001
Bowel wall thickening	1.99 (0.98-2.01)	0.24
Bowel loop dilation	2.21 (1.67-3.54)	0.03
Pneumatosis intestinalis	1.36 (1.23-3.15)	0.04
Ascites	1.40 (0.76-2.58)	0.28
Recent surgery	1.13 (0.54-2.38)	0.74
Intraperitoneal inflammation	1.63 (0.84-3.16)	0.15
Liver cirrhosis	2.44 (1.28-4.68)	0.007

OR: Odd ratio; CI: Confidence interval; DVT: Deep venous thrombosis.

Table 3 Multivariate logistic regression analysis of risk factors associated with transmural bowel infarction in the training cohort

Variable	β	OR	95%CI	P value
Decreased bowel wall enhancement	1.85	6.37	2.55-15.90	< 0.001
Rebound tenderness	1.97	7.14	2.73-18.65	< 0.001
Serum lactate levels > 2 mmol/L	1.44	3.14	1.33-7.41	0.009
DVT history	1.81	6.37	2.55-15.90	< 0.001

OR: Odd ratio; CI: Confidence interval; DVT: Deep venous thrombosis.

Table 4 Performance of the nomogram for estimating the risk of transmural bowel infarction

Variable	Value (95%CI)
	Training cohort (207)	Validation cohort (89)
Cutoff value	90	90
AUC	0.860 (0.771-0.925)	0.851 (0.796-0.897)
Sensitivity, %	88.89 (71.94-96.15)	84.48 (73.07-91.62)
Specificity, %	67.74 (55.37-78.05)	71.81 (64.11-78.42)
Positive predictive value, %	54.55 (40.07-68.29)	53.85 (43.66-63.72)
Negative predictive value, %	93.33 (82.14-97.71)	92.24 (85.91-95.86)
Positive likelihood ratio	2.76 (2.43-3.07)	3.00 (2.84-3.16)
Negative likelihood ratio	0.16 (0.08-0.32)	0.22 (0.17-0.27)
Diagnostic accuracy, %	74.16 (64.20-82.12)	75.36 (69.07-80.73)

AUC: Area under the receiver operator characteristic curve; CI: Confidence interval.