Construction of prediction model for acute hypertension following laparoscopic sleeve gastrectomy in obese patients

doi:10.16139/j.1007-9610.2025.05.05

Abstract

Abstract:

Objective To investigate the high-risk factors associated with acute postoperative hypertension (APH) following laparoscopic sleeve gastrectomy(LSG) in obese patients and to establish a predictive model. Methods A retrospective analysis was conducted on clinical data and laboratory parameters of obese patients who underwent LSG at Department of Metabolic Surgery in our hospital from August 2021 to December 2023. Logistic-LASSO regression analysis was used to identify independent risk factors for APH. A nomogram predictive model was developed based on these factors. The predictive performance and clinical utility of the model were assessed using the receiver operating characteristic (ROC) curve, Bootstrap resampling, calibration curve, Hosmer-Lemeshow (H-L) test, decision curve analysis (DCA), and clinical impact curve (CIC). Results The incidence of APH was 55.90%. Body mass index (BMI), platelet count, globulin, uric acid, sodium, fibrinogen, fasting blood glucose, and preoperative diastolic pressure had potential predictive value. Among them, BMI (OR=1.066, 95% CI: 1.003-1.137, P=0.046), platelet count (OR=0.994, 95% CI: 0.998-0.999, P=0.027), fibrinogen (OR=1.943, 95% CI: 1.128-3.479, P=0.02), and preoperative diastolic blood pressure (OR=0.953, 95% CI: 0.918-0.985, P = 0.006) were identified as independent high-risk factors. The area under the curve (AUC) of the nomogram was 0.783 (95% CI: 0.711-0.855), with a sensitivity of 0.817 and a specificity of 0.689. The AUC based on Bootstrap resampling was 0.776 (95% CI: 0.702-0.849). The H-L test yielded P>0.05, and the calibration curve showed good model fit. Both DCA and CIC demonstrated favorable screening efficiency. Conclusions BMI, platelet count, fibrinogen, and preoperative diastolic blood pressure are independent high-risk factors for APH following LSG. The developed nomogram model exhibits good predictive performance and clinical applicability, providing a valuable tool for early screening and prevention of APH in LSG patients.

Key words: Laparoscopic sleeve gastrectomy (LSG), Acute hypertension, Risk factor, Nomogram

CLC Number:

WANG Yue, GUO Junwei, YUAN Hang, DU Lei, JIA Xuyang, BU Le, Lu Liesheng. Construction of prediction model for acute hypertension following laparoscopic sleeve gastrectomy in obese patients[J]. Journal of Surgery Concepts & Practice, 2025, 30(05): 400-408.

Figures/Tables 10

Tab 1

Univariate analysis of LSG-OP occurrence of APH [M (Q1, Q3) / n(%) / $\bar{x} \pm s$]

Baseline indicator	ALL (n=161)	Non-APH (n=71)	APH (n=90)	Statistic value	P value
Age（year）	32(27, 37)	32(27, 37)	31(26, 38)	Z=-0.32	0.751
Sex				χ²=10.49	0.002
Male	110 (68.32)	58 (81.69)	52 (57.78)
Female	51 (31.68)	13 (18.31)	38 (42.22)
BMI（kg/m²）	38.50(34.72, 42.92)	36.73(34.08, 40.72)	40.09(35.77, 46.70)	Z=-2.97	0.003
Hypertension:				χ²=0.21	0.768
No	108 (67.08)	49 (69.01)	59 (65.56)
Yes	53 (32.92)	22 (30.99)	31 (34.44)
Diabetes:				χ²=0.23	0.753
No	101 (62.73)	46 (64.79)	55 (61.11)
Yes	60 (37.27)	25 (35.21)	35 (38.89)
WBC(×10⁹/L)	7.60(6.55, 8.89)	7.38(6.42, 8.86)	7.64(6.86, 9.09)	Z=-1.00	0.316
HB(g/L)	140.00(129.00, 148.00)	136.00(129.00, 145.00)	142.00(128.25, 150.00)	Z=-1.68	0.093
PLT(×10⁹/L)	295.14 ± 71.76	309.48 ± 62.53	283.83 ± 76.74	t=2.28	0.021
preALB(mg/L)	270.00 (239.00,304.00)	279.00 (247.00,304.50)	267.00 (238.00,299.75)	Z=-0.98	0.328
ALB(g/L)	42.47 ± 3.33	43.12 ± 3.56	41.95 ± 3.06	t=2.25	0.029
GLB(g/L)	30.60 (28.60,33.10)	31.30 (29.05,34.40)	30.20 (28.33,32.18)	Z=-1.74	0.082
DBIL(μmol/L)	3.70 (2.90,4.70)	3.70 (2.95,4.55)	3.65 (2.90,5.15)	Z=-0.18	0.854
TBIL(μmol/L)	10.90 (8.20,14.20)	10.60 (8.05,13.80)	11.30 (8.35,15.25)	Z=-0.72	0.474
ALT(U/L)	47.30 (24.20,87.80)	45.30 (24.15,83.30)	53.35 (24.80,101.43)	Z=-0.54	0.588
AST(U/L)	25.30 (17.40,45.90)	25.30 (17.05,41.70)	25.10 (17.42,46.88)	Z=-0.04	0.963
ALP(U/L)	71.70 (58.00,84.80)	70.70 (56.90,87.30)	71.80 (59.97,83.45)	Z=-0.06	0.950
GGT(U/L)	39.30 (27.60,63.00)	39.60 (28.80,63.65)	39.20 (26.82,62.77)	Z=-0.37	0.712
Urea(mmol/L)	4.40 (3.80,5.40)	4.40 (3.80,5.35)	4.35 (3.80,5.40)	Z=-0.22	0.827
Scr(μmol/L)	60.00 (53.00,67.00)	58.00 (52.00,64.50)	62.00 (53.25,70.75)	Z=-1.97	0.048
UA(μmol/L)	416.00 (358.00,495.00)	389.00 (348.00,460.00)	450.50 (365.25,523.25)	Z=-2.79	0.005
TC(mmol/L)	5.08 ± 0.87	5.08 ± 0.85	5.08 ± 0.90	t=-0.01	0.996
TG(mmol/L)	1.46 (1.02,2.15)	1.47 (1.03,2.14)	1.45 (1.02,2.15)	Z=-0.29	0.772
HDL(mmol/L)	1.05 (0.96,1.25)	1.06 (0.98,1.26)	1.04 (0.93,1.24)	Z=-0.85	0.395
LDL(mmol/L)	3.39 ± 0.85	3.41 ± 0.82	3.37 ± 0.87	t=0.33	0.741
K(mmol/L)	4.14 (3.93,4.30)	4.16 (3.94,4.28)	4.13 (3.93,4.32)	Z=-0.18	0.857
Na(mmol/L)	142.00 (140.00,143.00)	141.00 (140.00,143.00)	142.00 (141.00,143.00)	Z=-2.49	0.013
Mb(μg/L)	26.50 (20.30,35.30)	24.10 (19.10,30.50)	28.30 (21.22,40.43)	Z=-2.57	0.010
BNP(ng/L)	10.00 (10.00,10.00)	10.00 (10.00,10.00)	10.00 (10.00,10.00)	Z=-0.07	0.944
FIB(g/L)	3.31 (2.77,3.75)	3.23 (2.67,3.61)	3.36 (2.80,3.89)	Z=-1.49	0.136
HbA1c(%)	6.12 (5.67,6.65)	6.01 (5.69,6.58)	6.19 (5.66,6.77)	Z=-0.39	0.692
FPG(mmol/L)	5.32 (4.74,6.24)	5.26 (4.78,6.06)	5.37 (4.70,6.50)	Z=-0.25	0.805
CRP(mg/L)	6.28 (3.34,11.10)	5.54 (3.30,9.78)	6.58 (3.36,11.50)	Z=-1.10	0.270
preSBP(mmHg)	133.03 ± 14.46	134.31 ± 12.18	132.02 ± 16.03	t=1.03	0.305
preDBP(mmHg)	83.87 ± 11.60	85.96 ± 8.58	82.22 ± 13.33	t=2.15	0.033
MAP(mmHg)	101.00 (93.00,108.33)	102.67 (96.83,107.33)	99.83 (91.42,108.67)	Z=-1.47	0.140
Surgical time(min)	1.72 (1.50,2.08)	1.73 (1.49,2.04)	1.69 (1.50,2.15)	Z=-0.18	0.859

Tab 1

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Characteristics	OR	95% CI	P value
BMI (kg/m²)	1.066	(1.003-1.137)	0.046
PLT (10⁹/L)	0.994	(0.988-0.999)	0.027
GLB (g/L)	0.908	(0.810-1.009)	0.082
UA (μmol/L)	1.003	(0.999-1.006)	0.094
Na (mmol/L)	1.178	(0.985-1.420)	0.077
FIB (g/L)	1.943	(1.128-3.479)	0.020
FPG (mmol/L)	1.128	(0.965-1.337)	0.141
preDBP (mmHg)	0.953	(0.918-0.985)	0.006