Gallstone disease (GSD) is among the most common biliary tract diseases worldwide. Genetic and environmental factors have roles in its pathogenesis(17). Gallstone formation is multifactorial, involving a complex interplay of sex-specific, genetic, lifestyle, and comorbidity-related factors(18). A bloodstream infection is a pathogenic organism in the bloodstream that causes disease. It is typically defined by the growth of a pathogenic organism in culture or by the development of an atypical organism in conjunction with infection symptoms(19). Bloodstream infections are a severe disease of nosocomial infections with a high mortality rate. In recent years, catheter-associated bloodstream infections (CRBSI) have been the primary cause of bloodstream infections, and the associated complications are serious(20). Bloodstream infection is a common complication in patients with gallstones. Gallstones are the cause of cholestasis and can easily lead to bacterial infection. Via the portal system, these bacteria rapidly induce bloodstream infections. The bacterial culture approach is quite accurate and specific. however, it is incredibly time-consuming. Therefore, it is essential to provide strategies that can effectively predict the disease to prevent its occurrence, monitor its progression, and enhance the prognosis of patients.
Nomograms relied on user-friendly digital interfaces, enhanced accuracy, and easily comprehended prognoses to improve clinical decision-making(21). By forecasting patient outcomes and providing pertinent risk indicators and scores, they make disease monitoring easier. Individual clinical outcomes can be predicted based on a patient's individual characteristics, allowing for more individualized treatment(22). Jian Lv et al.. reported a nomogram model for predicting the prognosis of obstructive colorectal cancer(23). They also established a nomogram to assist healthcare professionals in assessing the risk of bullying victimization among adolescents, identifying high-risk groups, and implementing more effective preventive measures(24). Yinlong Ren et al.. found that nomograms can predict in-hospital mortality in ICU patients with sepsis and lung infection(25). Xiaoyu Guo et al. built a nomogram for clinical estimation of acute biliary pancreatitis risk among patients with symptomatic gallstones(26). Furthermore, this nomogram was not previously applied to gallstones or bloodstream infections until this study.
In this study, 357 patients with gallstones were included. Three optimal predictors were selected by multivariate logistic regression: age, PCT, and AST, and then a nomogram model was established. Relevant studies have reported that liver dysfunction is an early sign of BSI(27). WBC count(28), NE%(28), PCT(29), γ-GGT(29), TBIL(30), DBIL(31), ALP(32), and AST(32) are associated with liver dysfunction. The prediction model was consistent with the actual diagnosis and had good accuracy. The decision analysis curve demonstrated that when the threshold probability is 17%-77%, the nomogram is more clinically effective, which can serve as a theoretical reference for the individualized clinical prevention of gallstones complicated with bloodstream infection.
In the process of a bloodstream infection, pathogenic bacteria in the blood cause increased WBC and NE. PCT is elevated in patients with bloodstream infections due to the stimulation of various organs by inflammatory factors. A large amount of procalcitonin will be produced into the blood, significantly increasing serum procalcitonin level. This study revealed that PCT [OR = 2.115 (1.244–3.597), P = 0.006] and AST [OR = 3.469 (1.942–6.198), P = 0.000] were risk factors for gallstones complicated by bloodstream infection. Similar to previous research, a predictive biomarker indicating the risk of bacterial infections could guide clinical assessment and assist in the decision-making process for the judicious use of antimicrobials. In this regard, the use of a host-response marker, procalcitonin (PCT), has received ample scientific attention recently as an adjunct to clinical judgment(33). Nevertheless, age [OR = 0.562 (0.366–0.939), P = 0.028] was a protective factor for gallstones complicated with bloodstream infection. There has been reported that the rate of bloodstream infection increases with age(34). This difference may be related to the selected demographics. There are numerous risk factors for bloodstream infection, and a single risk factor cannot be used to determine whether gallstones are complicated by bloodstream infection, only by relying on a single risk factor. In this study, a nomogram prediction model was constructed using the optimized features, and the prediction efficiency was assessed. The nomogram model can recognize individualized prediction of clinical disease risk and has been extensively used in research(35). The clinician can predict the incidence of gallstones complicated with bloodstream infection by adding the scores corresponding to each independent risk factor on the nomogram and the predicted values through the total score.
Our study had several limitations. First, the small sample size and single-center design of our study could restrict how broadly applicable our approach can be.. Second, the nomogram of this model has only been bootstrapped, and external verification is needed for future study. Finally, the parameters included in this study are relatively single; additional factors in the model may affect the prediction results. Therefore, optimal features must be added to make the prediction model more accurate in clinical applications.