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

doi:10.4240/wjgs.v18.i1.112103

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastrointest Surg. Jan 27, 2026; 18(1): 112103
Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.112103

Table 1 Baseline data analysis between the acute respiratory distress syndrome group and the non-acute respiratory distress syndrome group, n (%)

Variables	Total (n = 176)	Non-ARDS group (n = 134)	ARDS group (n = 42)	Statistic	P value
Age, mean ± SD	64.36 ± 5.07	63.74 ± 4.86	66.36 ± 5.28	t = -2.99	0.003
BMI, mean ± SD	22.92 ± 3.29	22.98 ± 3.35	22.73 ± 3.12	t = 0.43	0.669
Preoperative RBC, mean ± SD	3.62 ± 0.65	3.58 ± 0.61	3.75 ± 0.79	t = -1.21	0.230
Preoperative WBC, mean ± SD	5.80 ± 0.97	5.71 ± 0.89	6.08 ± 1.14	t = -2.12	0.035
Preoperative ALB, mean ± SD	42.14 ± 2.52	42.41 ± 2.53	41.27 ± 2.34	t = 2.62	0.010
Preoperative Hb, mean ± SD	130.20 ± 9.66	130.72 ± 9.69	128.57 ± 9.47	t = 1.26	0.211
Preoperative PLT, mean ± SD	191.44 ± 25.80	189.47 ± 24.55	197.72 ± 28.86	t = -1.82	0.071
FEV1%, mean ± SD	88.13 ± 15.32	90.17 ± 15.62	81.64 ± 12.37	t = 3.23	0.001
FVC%, mean ± SD	78.11 ± 9.67	79.24 ± 9.75	74.47 ± 8.54	t = 2.84	0.005
Operation time, mean ± SD	182.83 ± 23.05	181.36 ± 22.51	187.52 ± 24.37	t = -1.52	0.131
Preoperative bleeding, mean ± SD	51.68 ± 12.40	51.19 ± 11.74	53.24 ± 14.33	t = -0.94	0.351
Sex				χ² = 0.08	0.784
Female	66 (37.50)	51 (38.06)	15 (35.71)
Male	110 (62.50)	83 (61.94)	27 (64.29)
Smoking				χ² = 4.81	0.028
No	93 (52.84)	77 (57.46)	16 (38.10)
Yes	83 (47.16)	57 (42.54)	26 (61.90)
Hypertension				χ² = 0.67	0.414
No	114 (64.77)	89 (66.42)	25 (59.52)
Yes	62 (35.23)	45 (33.58)	17 (40.48)
Diabetes				χ² = 0.89	0.345
No	163 (92.61)	126 (94.03)	37 (88.10)
Yes	13 (7.39)	8 (5.97)	5 (11.90)
Tumor location				χ² = 4.24	0.236
Intestine	86 (48.86)	71 (52.99)	15 (35.71)
Stomach	34 (19.32)	25 (18.66)	9 (21.43)
Liver and gallbladder	30 (17.05)	20 (14.93)	10 (23.81)
Pancreas	26 (14.77)	18 (13.43)	8 (19.05)
TNM staging				χ² = 5.58	0.018
I/II	99 (56.25)	82 (61.19)	17 (40.48)
III/IV	77 (43.75)	52 (38.81)	25 (59.52)
Preoperative pulmonary infection				χ² = 5.16	0.023
No	125 (71.02)	101 (75.37)	24 (57.14)
Yes	51 (28.98)	33 (24.63)	18 (42.86)
Surgical method				χ² = 1.70	0.192
Laparoscopic surgery	127 (72.16)	100 (74.63)	27 (64.29)
Open surgery	49 (27.84)	34 (25.37)	15 (35.71)
Intraoperative fluid replacement				χ² = 0.33	0.566
< 2000 mL	78 (44.32)	61 (45.52)	17 (40.48)
≥ 2000 mL	98 (55.68)	73 (54.48)	25 (59.52)
Postoperative infection				χ² = 0.69	0.406
No	138 (78.41)	107 (79.85)	31 (73.81)
Yes	38 (21.59)	27 (20.15)	11 (26.19)
Postoperative fever				χ² = 1.43	0.233
No	122 (69.32)	96 (71.64)	26 (61.90)
Yes	54 (30.68)	38 (28.36)	16 (38.10)
Anastomotic fistula				χ² = 9.71	0.002
No	161 (91.48)	128 (95.52)	33 (78.57)
Yes	15 (8.52)	6 (4.48)	9 (21.43)

ARDS: Acute respiratory distress syndrome; BMI: Body mass index; RBC: Red blood cell; WBC: White blood cell; ALB: Albumin; Hb: Hemoglobin; PLT: Platelets; FEV1%: Preoperative percentage of forced expiratory volume in 1 second; FVC%: Preoperative percentage of forced vital capacity; TNM: Tumor-node-metastasis.

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Table 2 Univariate logistic regression analysis

Variables	β	SE	Z	P value	OR (95%CI)
Age	0.11	0.04	2.85	0.004	1.12 (1.04-1.21)
BMI	-0.02	0.05	-0.43	0.667	0.98 (0.88-1.09)
Preoperative RBC	0.38	0.27	1.38	0.167	1.46 (0.85-2.48)
Preoperative WBC	0.41	0.20	2.08	0.038	1.51 (1.02-2.23)
Preoperative ALB	-0.19	0.07	-2.53	0.011	0.83 (0.72-0.96)
Preoperative Hb	-0.02	0.02	-1.25	0.211	0.98 (0.94-1.01)
Preoperative PLT	0.01	0.01	1.79	0.073	1.01 (1.00-1.03)
FEV1%	-0.04	0.01	-3.08	0.002	0.96 (0.94-0.99)
FVC%	-0.05	0.02	-2.73	0.006	0.95 (0.91-0.99)
Operation time	0.01	0.01	1.51	0.132	1.01 (1.00-1.03)
Preoperative bleeding	0.01	0.01	0.94	0.349	1.01 (0.99-1.04)
Sex
Female	-	-	-	-	1.00 (reference)
Male	0.10	0.37	0.27	0.784	1.11 (0.54-2.27)
Smoking
No	-	-	-	-	1.00 (reference)
Yes	0.79	0.36	2.17	0.030	2.20 (1.08-4.47)
Hypertension
No	-	-	-	-	1.00 (reference)
Yes	0.30	0.36	0.81	0.415	1.34 (0.66-2.74)
Diabetes
No	-	-	-	-	1.00 (reference)
Yes	0.76	0.60	1.26	0.208	2.13 (0.66-6.90)
Tumor location
Intestine	-	-	-	-	1.00 (reference)
Stomach	0.53	0.48	1.11	0.268	1.70 (0.66-4.38)
Liver and gallbladder	0.86	0.48	1.79	0.073	2.37 (0.92-6.07)
Pancreas	0.74	0.51	1.45	0.146	2.10 (0.77-5.73)
TNM staging
I/II	-	-	-	-	1.00 (reference)
III/IV	0.84	0.36	2.33	0.020	2.32 (1.14-4.70)
Preoperative pulmonary infection
No	-	-	-	-	1.00 (reference)
Yes	0.83	0.37	2.24	0.025	2.30 (1.11-4.75)
Surgical method
Laparoscopic surgery	-	-	-	-	1.00 (reference)
Open surgery	0.49	0.38	1.30	0.194	1.63 (0.78-3.43)
Intraoperative fluid replacement
< 2000 mL	-	-	-	-	1.00 (reference)
≥ 2000 mL	0.21	0.36	0.57	0.566	1.23 (0.61-2.48)
Postoperative infection
No	-	-	-	-	1.00 (reference)
Yes	0.34	0.41	0.83	0.408	1.41 (0.63-3.15)
Postoperative fever
No	-	-	-	-	1.00 (reference)
Yes	0.44	0.37	1.19	0.234	1.55 (0.75-3.22)
Anastomotic fistula
No	-	-	-	-	1.00 (reference)
Yes	1.76	0.56	3.13	0.002	5.82 (1.93-17.51)

CI: Confidence interval; OR: Odds ratio; BMI: Body mass index; RBC: Red blood cell; WBC: White blood cell; ALB: Albumin; Hb: Hemoglobin; PLT: Platelets; FEV1%: Preoperative percentage of forced expiratory volume in 1 second; FVC%: Preoperative percentage of forced vital capacity; TNM: Tumor-node-metastasis.

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Table 3 Multivariate logistic regression analysis

Variables	β	SE	Z	P value	OR (95%CI)
Intercept	6.33	4.67	1.35	0.176	559.39 (0.06-5308961.64)
Smoking
No	-	-	-	-	1.00 (reference)
Yes	1.15	0.46	2.50	0.012	3.17 (1.28-7.84)
Preoperative pulmonary infection
No	-	-	-	-	1.00 (reference)
Yes	1.12	0.46	2.43	0.015	3.07 (1.24-7.61)
Anastomotic fistula
No	-	-	-	-	1.00 (reference)
Yes	1.51	0.66	2.29	0.022	4.55 (1.24-16.67)
Age	0.21	0.06	3.80	< 0.001	1.24 (1.11-1.38)
Preoperative ALB	-0.34	0.11	-2.98	0.003	0.71 (0.57-0.89)
FEV1%	-0.04	0.02	-2.77	0.006	0.96 (0.93-0.99)
FVC%	-0.06	0.02	-2.50	0.012	0.94 (0.89-0.99)

CI: Confidence interval; OR: Odds ratio; ALB: Albumin; FEV1%: Preoperative percentage of forced expiratory volume in 1 second; FVC%: Preoperative percentage of forced vital capacity.

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Table 4 Clinical application of the predictive model

Prediction result	Gold standard		Total
Prediction result	ARDS	Non-ARDS	Total
ARDS	8	4	12
Non-ARDS	8	48	56
Total	16	52	68

ARDS: Acute respiratory distress syndrome.

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Citation: Zhen J, Chen W, Xu YF, Ma YM. Risk factors and prediction model for acute respiratory distress syndrome in patients with digestive tumor after surgery. World J Gastrointest Surg 2026; 18(1): 112103
URL: https://www.wjgnet.com/1948-9366/full/v18/i1/112103.htm
DOI: https://dx.doi.org/10.4240/wjgs.v18.i1.112103