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Construction and validation of a risk-prediction model for hypovolemic shock after cytoreductive surgery in patients with ovarian cancer

emergency-and-critical-care
oncology
surgery-and-surgical-specialties

Abstract

Introduction. Ovarian cancer patients undergoing cytoreductive surgery are prone to hypovolemic shock in the early postoperative period, resulting in tissue hypoperfusion, lactic acid accumulation, endotoxin displacement, and even multiple organ dysfunction syndrome; however, in existing studies, there is a lack of a dynamic approach to assess the risk of this complication. This study aimed to construct and validate a visual prediction model of hypovolemic shock after cytoreductive surgery in patients with ovarian cancer.

Methods. This was a retrospective observational study. Patients with ovarian cancer who received cytoreductive surgery at Zhejiang Cancer Hospital between January 2023 and June 2024 were retrospectively enrolled and divided into a training group and a validation group. Predictive factors for hypovolemic shock were identified using univariable and multivariable logistic regression analyses, and a risk prediction model based on the nomogram was constructed and validated internally. Nomogram performance was assessed using receiver operating characteristic (ROC), calibration curve, and decision curve analysis (DCA).

Results. A total of 423 patients were eligible for inclusion in this study. There were 301 cases in the training group and 122 cases in the validation group. This visual prediction model was constructed based on the duration of the operation, the amount of blood lost during the operation, the amount of albumin and fibrinogen immediately after the operation, and the postoperative use of sedative drugs. The area under the ROC of the nomogram for the training and validation cohorts was 0.800 and 0.821, respectively, with 95% confidence intervals (CIs) of 0.740-0.860 and 0.735-0.907. The calibration curve indicated good concordance between experimental and projected values, and the DCA proved good clinical applicability.

Conclusions. The model constructed in this study demonstrates improved predictive accuracy for the risk of hypovolemic shock after cytoreductive surgery in patients with ovarian cancer, and it holds the potential to provide a basis for medical staff to achieve early identification and timely intervention.

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