Development and validation of a nomogram for predicting perioperative transfusion in children undergoing cardiac surgery with CPB

Abstract

Background: Timely recognition of perioperative red blood cell transfusion (PRT) risk is crucial for developing personalized blood management strategies in pediatric patients. In this study, we sought to construct a prediction model for PRT risk in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Methods: From September 2014 to December 2021, 23,884 pediatric patients under the age of 14 were randomly divided into training and testing cohorts at a 7:3 ratio. Variable selection was performed using univariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression. Multivariate logistic regression was then used to identify predictors, and a nomogram was developed to predict PRT risk. The model’s performance was evaluated based on discrimination, calibration, and clinical utility in both cohorts. Results: After multiple rounds of variable selection, eight predictors of PRT risk were identified: age, weight, preoperative hemoglobin levels, presence of cyanotic congenital heart disease, CPB duration, minimum rectal temperature during CPB, CPB priming volume, and the use of a small incision. The predictive model incorporating these variables demonstrated strong performance, with an area under the curve (AUC) of 0.886 (95% CI: 0.880–0.891) in the training cohort and 0.883 (95% CI: 0.875–0.892) in the testing cohort. The calibration plot closely aligned with the ideal diagonal line, and decision curve analysis indicated that the model provided a net clinical benefit. Conclusions: Our predictive model exhibits good performance in assessing PRT risk in pediatric patients undergoing cardiac surgery with CPB, providing clinicians a practical tool to optimize individualized perioperative blood management strategies for this vulnerable population.