Development and internal validation of clinical prediction models for outcomes of complicated intra-abdominal infection.

BACKGROUND: Complicated intra-abdominal infections (cIAIs) are associated with significant morbidity and mortality. The aim of this study was to describe the clinical characteristics of patients with cIAI in a multicentre study and to develop clinical prediction models (CPMs) to help identify patients at risk of mortality or relapse. METHODS: A multicentre observational study was conducted from August 2016 to February 2017 in the UK. Adult patients diagnosed with cIAI were included. Multivariable logistic regression was performed to develop CPMs for mortality and cIAI relapse. The c-statistic was used to test model discrimination. Model calibration was tested using calibration slopes and calibration in the large (CITL). The CPMs were then presented as point scoring systems and validated further. RESULTS: Overall, 417 patients from 31 surgical centres were included in the analysis. At 90 days after diagnosis, 17.3 per cent had a cIAI relapse and the mortality rate was 11.3 per cent. Predictors in the mortality model were age, cIAI aetiology, presence of a perforated viscus and source control procedure. Predictors of cIAI relapse included the presence of collections, outcome of initial management, and duration of antibiotic treatment. The c-statistic adjusted for model optimism was 0.79 (95 per cent c.i. 0.75 to 0.87) and 0.74 (0.73 to 0.85) for mortality and cIAI relapse CPMs. Adjusted calibration slopes were 0.88 (95 per cent c.i. 0.76 to 0.90) for the mortality model and 0.91 (0.88 to 0.94) for the relapse model; CITL was -0.19 (95 per cent c.i. -0.39 to -0.12) and - 0.01 (- 0.17 to -0.03) respectively. CONCLUSION: Relapse of infection and death after complicated intra-abdominal infections are common. Clinical prediction models were developed to identify patients at increased risk of relapse or death after treatment, these now require external validation.

Expression of nestin in remodelling of α-naphthylisothiocyanate-induced acute bile duct injury in rats.

The function of the intermediate filament protein nestin is poorly understood. The significance of nestin expression was assessed in α-naphthylisothiocyanate (ANIT)-induced cholangiocyte injury lesions in F344 rats. Liver samples obtained from rats injected intraperitoneally with ANIT (75 mg/kg) on post-injection days 0 (control) and 1-12 were labelled immunohistochemically for expression of nestin and markers specific for mesenchymal cells (vimentin), hepatic stellate cells (HSCs) (desmin and glial fibrillary acidic protein [GFAP]), endothelial cells (rat endothelial cell antigen [RECA]-1), cholangiocytes (cytokeratin [CK] 19) and cellular proliferation (Ki67). Cholangiocyte injury led to infiltration of neutrophils and macrophages followed by aggregation of mesenchymal cells and regeneration of bile ducts. Nestin expression was detected in mesenchymal cells (vimentin positive) on days 1-7 with a peak on days 3-5 and in newly-formed RECA-1-positive endothelial cells on day 3. Nestin expression was also observed in regenerating CK19-positive cholangiocytes on days 2-5, with a peak on day 3. Labelling for Ki67 showed proliferation of cholangiocytes, mesenchymal cells and HSCs. Real-time reverse transcriptase polymerase chain reaction with microdissected samples showed significantly elevated nestin mRNA on day 3. The findings suggest an association between nestin expression and cellular proliferation. Based on these findings, it was considered that nestin-expressing mesenchymal cells, HSCs and endothelial cells may be possible progenitors of repopulating cholangiocytes. Nestin expression may serve as an indicator for cellular remodelling and behaviour of injured and repopulating bile ducts.