ArticleSurgical endoscopy2026
Development and validation of a nomogram for spontaneous closure of duodenal fistulas after infection control in septic patients.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn septic patients, the rate of spontaneous closure is lower than in non-infected patients. Few studies have focused on predicting spontaneous closure after sepsis control, which is crucial for guiding treatment decisions such as surgery or observation. This study developed and validated a nomogram to predict the likelihood of spontaneous closure in external duodenal fistulas after infection control in septic patients.
methodsBetween January 2004 and October 2024, patients from centers A and B were included in the development cohort, while those from centers C and D constituted the external validation cohort. Key risk factors for spontaneous closure were identified and incorporated into the nomogram. Its performance was evaluated using calibration and decision curve.
resultsA total of 449 patients were included in the study: 342 in the development cohort and 107 in the external validation cohort. The rates of spontaneous closure were 53.2% and 57%, respectively. Six significant factors influencing closure were identified: the interval between fistula occurrence and infection control, the extent of infection invading the retroperitoneum, the occurrence of emergency laparotomy, fistula diameter greater than 2 cm, duodenal decompression, and the need for intermittent albumin transfusions after infection control. The nomogram demonstrated strong predictive accuracy, with C-indices of 0.82 for the development cohort and 0.76 for the validation cohort. An optimal cut-off score of 155 exhibited high sensitivity and specificity across both cohorts.
conclusionThis study introduces a practical nomogram to assess the risk of spontaneous closure in external duodenal fistulas after infection control in septic patients.
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