Risk factors and prediction model for acute respiratory distress syndrome in patients with digestive tumor after surgery

Abstract

BACKGROUND

Postoperative acute respiratory distress syndrome (ARDS) after digestive tumors is a serious complication that severely affects patients’ prognosis; however, systematic studies assessing its risk factors are lacking, and effective prediction models are urgently required.

AIM

To investigate the risk factors for postoperative ARDS in patients with digestive tumors and construct a prediction model.

METHODS

Overall, 42 of the 176 patients developed ARDS, with an incidence rate of 23.86%. Multifactorial logistic regression analysis identified advanced age [odds ratio (OR) = 1.24, P < 0.001], smoking history (OR = 3.17, P = 0.012), preoperative lung infection (OR = 3.07, P = 0.015), low preoperative albumin level (OR = 0.71, P = 0.003), preoperative percentage of forced expiratory volume in 1 second, (OR = 0.96, P = 0.006), preoperative percentage of forced vital capacity (OR = 0.94, P = 0.012), and postoperative anastomotic fistula (OR = 4.55, P = 0.022) as independent risk factors for postoperative ARDS. The nomogram prediction model showed good discriminatory power [area under the curve (AUC) = 0.86] and goodness of fit (Hosmer-Lemeshow, P = 0.729). The internal validation demonstrated an AUC of 0.86 and a good calibration curve fit (Hosmer-Lemeshow, P = 0.914). Prospective clinical validation confirmed the reliability and clinical value of the model (AUC = 0.91, accuracy = 82.35%).

RESULTS

Overall, 42 of the 176 patients developed ARDS, with an incidence rate of 23.86%. Multifactorial logistic regression analysis identified advanced age (OR = 1.24, P < 0.001), smoking history (OR = 3.17, P = 0.012), preoperative lung infection (OR = 3.07, P = 0.015), low preoperative albumin level (OR = 0.71, P = 0.003), preoperative percentage of forced expiratory volume in 1 second, (OR = 0.96, P = 0.006), preoperative percentage of forced vital capacity (OR = 0.94, P = 0.012), and postoperative anastomotic fistula (OR = 4.55, P = 0.022) as independent risk factors for postoperative ARDS. The nomogram prediction model showed good discriminatory power (AUC = 0.86) and goodness of fit (Hosmer-Lemeshow, P = 0.729). The internal validation demonstrated an AUC of 0.86 and a good calibration curve fit (Hosmer-Lemeshow, P = 0.914). Prospective clinical validation confirmed the reliability and clinical value of the model (AUC = 0.91, accuracy = 82.35%).

CONCLUSION

The nomogram prediction model based on independent risk factors for postoperative ARDS in patients with digestive tumors demonstrated good differentiation, calibration, and clinical utility and helped identify high-risk patients early.

Keywords: Digestive tumor; Acute respiratory distress syndrome; Risk factors; Prediction model; Surgery; Clinical value

Core Tip: This study identified advanced age, smoking history, preoperative pulmonary infection, hypoalbuminemia, impaired pulmonary function, and anastomotic leakage as key risk factors for postoperative acute respiratory distress syndrome in patients with digestive tumors. A novel nomogram prediction model based on these factors demonstrated excellent discriminative ability (area under the curve = 0.86-0.91) in identifying high-risk patients. These findings emphasize the importance of preoperative optimization (e.g., smoking cessation, infection control, and nutritional support) and postoperative vigilance, particularly in patients with poor pulmonary reserve. This practical tool enables individualized risk assessment and early intervention to reduce acute respiratory distress syndrome incidence and improve surgical outcomes.