A nomogram for predicting choledochal cyst with perforation
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In brief
In brief
This study developed a clinical nomogram to predict choledochal cyst perforation in pediatric patients, identifying eight key predictive factors including age (peak risk 1-3 years), liver enzymes, inflammatory markers, and clinical symptoms. The validated tool demonstrates strong discriminative ability and clinical utility for early identification of this rare but serious complication.
- Choledochal cyst perforation occurs predominantly in children aged 1-3 years, requiring heightened clinical suspicion in this age group.
- Eight clinical and laboratory factors predict perforation risk: age, ALT, GGT, CRP, vomiting, jaundice, abdominal distension, and diarrhea.
- A validated nomogram combining these predictors demonstrates strong discriminative ability for identifying perforation risk preoperatively.
- Early recognition using the nomogram enables timely surgical intervention, which is crucial for outcomes in this rare complication.
- The model was developed from 1111 surgical cases over 11 years, providing robust evidence for clinical decision-making.
Written by the GCMD Library team from the article.
Abstract
Background
Choledochal cyst with perforation (CC with perforation) rarely occurs, early diagnosis and timely treatment plan are crucial for the treatment of CC with perforation. This study aims to forecast the occurrence of CC with perforation.
Methods
All 1111 patients were conducted, who underwent surgery for choledochal cyst at our hospital from January 2011 to October 2022. We conducted univariate and multivariate logistic regression analysis to screen for independent predictive factors for predicting CC with perforation, upon which established a nomogram. The predictive performance of the nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) curves.
Results
The age of children with choledochal cyst perforation is mainly concentrated between 1 and 3 years old. Logistic regression analysis indicates that age, alanine aminotransferase, glutamyl transpeptidase, C-reactive protein, vomiting, jaundice, abdominal distension, and diarrhea are associated with predicting the occurrence of choledochal cyst perforation. ROC curves, calibration plots, and DCA curve analysis curves demonstrate that the nomogram has great discriminative ability and calibration, as well as significant clinical utility.
Conclusion
The age of CC with perforation is mainly concentrated between 1 and 3 years old. A nomogram for predicting the perforation of choledochal cyst was established.