Journal of Southern Medical University ›› 2025, Vol. 45 ›› Issue (3): 514-521.doi: 10.12122/j.issn.1673-4254.2025.03.09
Lin SHEN1(
), Cuihao SONG1(), Congmin WANG2, Xi GAO3, Junhong AN4, Chengxin LI1(), Bin LIANG5(), Xia LI6()
Received:2024-12-16
Online:2025-03-20
Published:2025-03-28
Contact:
Chengxin LI, Bin LIANG, Xia LI
E-mail:linlinshen1995@126.com;18110026396@163.com;chengxinderm@163.com;echo_lb666@163.com;1648248514@qq.com
Supported by:Lin SHEN, Cuihao SONG, Congmin WANG, Xi GAO, Junhong AN, Chengxin LI, Bin LIANG, Xia LI. Risk factors for malnutrition in ulcerative colitis complicated with pyoderma gangrenosum and construction of a lasso regression-based prediction model[J]. Journal of Southern Medical University, 2025, 45(3): 514-521.
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URL: https://www.j-smu.com/EN/10.12122/j.issn.1673-4254.2025.03.09
| Project | Unhealthy group (n=185) | Good group (n=92) | t/x2 | P |
|---|---|---|---|---|
| Gender | 5.988 | 0.014 | ||
| Male | 109 (58.92) | 68 (73.91) | ||
| Female | 76 (41.08) | 24 (26.09) | ||
| Age (year) | 59.63±14.62 | 52.82±13.94 | 3.165 | 0.002 |
| Education level | 6.243 | 0.044 | ||
| Elementary school or below | 99 (53.51) | 37 (40.22) | ||
| High school | 58 (31.35) | 31 (33.70) | ||
| University | 28 (15.14) | 24 (26.01) | ||
| Marital status in the past year | 6.104 | 0.047 | ||
| Unmarried | 16 (8.65) | 3 (3.26) | ||
| Divorced/widowed | 34 (18.38) | 10 (10.87) | ||
| In marriage | 135 (72.97) | 79 (85.87) | ||
| Body mass index (kg/m2) | 21.80±3.47 | 24.52±2.95 | -10.416 | <0.001 |
| Residential area in the past year | 11.457 | 0.003 | ||
| Rural area | 92 (49.73) | 33 (35.87) | ||
| Town | 37 (20.00) | 12 (13.04) | ||
| Urban area | 56 (30.27) | 47 (51.09) | ||
| Residential partner in the past year | 7.497 | 0.024 | ||
| Live alone | 41 (22.16) | 9 (9.78) | ||
| Friends/relatives | 10 (5.41) | 3 (3.26) | ||
| Spouse/children | 134 (72.43) | 80 (86.96) | ||
| Economic pressure in the past year | 25.668 | <0.001 | ||
| No | 30 (16.22) | 39 (42.39) | ||
| General | 67 (36.22) | 31 (33.70) | ||
| Larger | 88 (47.56) | 22 (23.91) |
Tab.1 Comparison of general demographic data between the two groups ［Mean±SD, n(%)］
| Project | Unhealthy group (n=185) | Good group (n=92) | t/x2 | P |
|---|---|---|---|---|
| Gender | 5.988 | 0.014 | ||
| Male | 109 (58.92) | 68 (73.91) | ||
| Female | 76 (41.08) | 24 (26.09) | ||
| Age (year) | 59.63±14.62 | 52.82±13.94 | 3.165 | 0.002 |
| Education level | 6.243 | 0.044 | ||
| Elementary school or below | 99 (53.51) | 37 (40.22) | ||
| High school | 58 (31.35) | 31 (33.70) | ||
| University | 28 (15.14) | 24 (26.01) | ||
| Marital status in the past year | 6.104 | 0.047 | ||
| Unmarried | 16 (8.65) | 3 (3.26) | ||
| Divorced/widowed | 34 (18.38) | 10 (10.87) | ||
| In marriage | 135 (72.97) | 79 (85.87) | ||
| Body mass index (kg/m2) | 21.80±3.47 | 24.52±2.95 | -10.416 | <0.001 |
| Residential area in the past year | 11.457 | 0.003 | ||
| Rural area | 92 (49.73) | 33 (35.87) | ||
| Town | 37 (20.00) | 12 (13.04) | ||
| Urban area | 56 (30.27) | 47 (51.09) | ||
| Residential partner in the past year | 7.497 | 0.024 | ||
| Live alone | 41 (22.16) | 9 (9.78) | ||
| Friends/relatives | 10 (5.41) | 3 (3.26) | ||
| Spouse/children | 134 (72.43) | 80 (86.96) | ||
| Economic pressure in the past year | 25.668 | <0.001 | ||
| No | 30 (16.22) | 39 (42.39) | ||
| General | 67 (36.22) | 31 (33.70) | ||
| Larger | 88 (47.56) | 22 (23.91) |
| Project | unhealthy group (n=185) | Good group (n=92) | t/x2 | P |
|---|---|---|---|---|
| Exercise frequency in past year | 3.714 | 0.156 | ||
| Less | 43 (23.24) | 16 (17.39) | ||
| General | 81 (43.78) | 35 (38.04) | ||
| Often | 61 (32.98) | 41 (44.57) | ||
| Types of food in past year | 26.339 | <0.001 | ||
| Less | 85 (45.95) | 27 (29.35) | ||
| General | 66 (35.68) | 21 (22.83) | ||
| Often | 34 (18.37) | 44 (47.82) | ||
| Dietary preference in past year | 7.407 | 0.025 | ||
| Less | 48 (25.95) | 11 (11.96) | ||
| General | 62 (33.51) | 34 (36.96) | ||
| Often | 75 (40.54) | 47 (51.08) | ||
| Smoking in past year | 0.827 | 0.661 | ||
| Less | 109 (58.92) | 58 (63.04) | ||
| General | 42 (22.70) | 21 (22.83) | ||
| Often | 34 (18.38) | 13 (14.13) | ||
| Drinking in the past year | 9.568 | 0.008 | ||
| Less | 95 (51.35) | 62 (67.39) | ||
| General | 48 (25.95) | 22 (23.91) | ||
| Often | 42 (22.70) | 8 (8.70) |
Tab.2 Comparison of living and eating habits of the patients between the two groups ［n(%)］
| Project | unhealthy group (n=185) | Good group (n=92) | t/x2 | P |
|---|---|---|---|---|
| Exercise frequency in past year | 3.714 | 0.156 | ||
| Less | 43 (23.24) | 16 (17.39) | ||
| General | 81 (43.78) | 35 (38.04) | ||
| Often | 61 (32.98) | 41 (44.57) | ||
| Types of food in past year | 26.339 | <0.001 | ||
| Less | 85 (45.95) | 27 (29.35) | ||
| General | 66 (35.68) | 21 (22.83) | ||
| Often | 34 (18.37) | 44 (47.82) | ||
| Dietary preference in past year | 7.407 | 0.025 | ||
| Less | 48 (25.95) | 11 (11.96) | ||
| General | 62 (33.51) | 34 (36.96) | ||
| Often | 75 (40.54) | 47 (51.08) | ||
| Smoking in past year | 0.827 | 0.661 | ||
| Less | 109 (58.92) | 58 (63.04) | ||
| General | 42 (22.70) | 21 (22.83) | ||
| Often | 34 (18.38) | 13 (14.13) | ||
| Drinking in the past year | 9.568 | 0.008 | ||
| Less | 95 (51.35) | 62 (67.39) | ||
| General | 48 (25.95) | 22 (23.91) | ||
| Often | 42 (22.70) | 8 (8.70) |
| Project | Unhealthy group (n=185) | Good group (n=92) | t/x2 | P |
|---|---|---|---|---|
| Duration of ulcerative colitis (months) | 93.19±48.83 | 49.01±31.29 | 12.18 | 0.000 |
| Lesion site of colitis | 15.374 | 0.000 | ||
| Rectum | 34 (18.38) | 37 (40.22) | ||
| Colon | 151 (81.62) | 55 (59.78) | ||
| Colitis activity | 48.751 | 0.000 | ||
| Mild | 41 (22.16) | 55 (59.78) | ||
| Moderate | 85 (45.95) | 34 (36.96) | ||
| Severe | 59 (31.89) | 3 (3.26) | ||
| Course of pyoderma gangrenosum (months) | 10.99±4.94 | 6.11±3.26 | 8.591 | 0.000 |
| Classification of pyoderma | 5.704 | 0.058 | ||
| Kuitang type | 78 (42.16) | 29 (31.52) | ||
| Pustular type | 42 (22.70) | 17 (18.48) | ||
| Proliferative type | 65 (35.14) | 46 (50.00) | ||
| Number of chronic diseases (types) | 4.18±2.85 | 2.89±2.02 | 6.814 | 0.000 |
| Self care ability | 14.304 | 0.001 | ||
| Unable to care on self | 11 (5.95) | 1 (1.09) | ||
| Partially self-care | 62 (33.51) | 15 (16.30) | ||
| Completely self-care | 112 (60.5) | 76 (82.61) | ||
| Sds score | 59.78±13.81 | 50.85±12.68 | 5.206 | 0.000 |
| Sas score | 62.98±12.26 | 51.83±11.33 | 6.004 | 0.000 |
| Denture or dental problems | 34 (18.38) | 5 (5.43) | 8.510 | 0.004 |
| Sleep quality in recent half a year | 47.101 | 0.000 | ||
| Poor | 85 (45.95) | 22 (23.91) | ||
| General | 94 (50.81) | 41 (44.57) | ||
| Better | 6 (3.24) | 29 (31.52) |
Tab.3 Comparison of disease-related data between the two groups ［Mean±SD, n(%)］
| Project | Unhealthy group (n=185) | Good group (n=92) | t/x2 | P |
|---|---|---|---|---|
| Duration of ulcerative colitis (months) | 93.19±48.83 | 49.01±31.29 | 12.18 | 0.000 |
| Lesion site of colitis | 15.374 | 0.000 | ||
| Rectum | 34 (18.38) | 37 (40.22) | ||
| Colon | 151 (81.62) | 55 (59.78) | ||
| Colitis activity | 48.751 | 0.000 | ||
| Mild | 41 (22.16) | 55 (59.78) | ||
| Moderate | 85 (45.95) | 34 (36.96) | ||
| Severe | 59 (31.89) | 3 (3.26) | ||
| Course of pyoderma gangrenosum (months) | 10.99±4.94 | 6.11±3.26 | 8.591 | 0.000 |
| Classification of pyoderma | 5.704 | 0.058 | ||
| Kuitang type | 78 (42.16) | 29 (31.52) | ||
| Pustular type | 42 (22.70) | 17 (18.48) | ||
| Proliferative type | 65 (35.14) | 46 (50.00) | ||
| Number of chronic diseases (types) | 4.18±2.85 | 2.89±2.02 | 6.814 | 0.000 |
| Self care ability | 14.304 | 0.001 | ||
| Unable to care on self | 11 (5.95) | 1 (1.09) | ||
| Partially self-care | 62 (33.51) | 15 (16.30) | ||
| Completely self-care | 112 (60.5) | 76 (82.61) | ||
| Sds score | 59.78±13.81 | 50.85±12.68 | 5.206 | 0.000 |
| Sas score | 62.98±12.26 | 51.83±11.33 | 6.004 | 0.000 |
| Denture or dental problems | 34 (18.38) | 5 (5.43) | 8.510 | 0.004 |
| Sleep quality in recent half a year | 47.101 | 0.000 | ||
| Poor | 85 (45.95) | 22 (23.91) | ||
| General | 94 (50.81) | 41 (44.57) | ||
| Better | 6 (3.24) | 29 (31.52) |
Fig.1 Lasso regression coefficient diagram and cross validation diagram. Lasso regression was used to analyze the association between each index and nutritional risk of the patients.
Fig.2 Nomogram prediction model of nutritional risk in patients with ulcerative colitis complicated with pyoderma gangrenosum based on the duration of ulcerative colitis, colitis activity, duration of pyoderma, number of chronic diseases, SAS score and sleep quality, showing the weighted scores of the 6 risk factors and the risk levels of the total score.
| Factors | β | S.E | Z | P | OR (95% CI) |
|---|---|---|---|---|---|
| Duration of ulcerative colitis | 0.065 | 0.017 | 3.922 | 0.000 | 1.067 (1.033-1.102) |
| Colitis activity | |||||
| Mild | 1.000 | ||||
| Moderate | 2.541 | 1.116 | 2.277 | 0.023 | 2.694 (1.425-3.071) |
| Severe | 2.600 | 1.046 | 2.484 | 0.013 | 3.460 (1.731-4.645) |
| Course of pyoderma gangrenosum | 0.539 | 0.164 | 3.280 | 0.001 | 1.715 (1.242-2.367) |
| Number of chronic diseases | 0.621 | 0.188 | 3.302 | 0.000 | 1.861 (1.287-2.690) |
| Sleep quality | |||||
| Better | 1.000 | ||||
| General | 0.742 | 0.950 | 0.781 | 0.435 | 1.101 (0.326-3.529) |
| Poor | 3.814 | 1.187 | 3.214 | 0.001 | 3.336 (1.429-6.088) |
| Sas score | 0.192 | 0.052 | 3.727 | 0.000 | 1.112 (1.025-1.341) |
Tab.4 Results of multivariate logistic regression analysis
| Factors | β | S.E | Z | P | OR (95% CI) |
|---|---|---|---|---|---|
| Duration of ulcerative colitis | 0.065 | 0.017 | 3.922 | 0.000 | 1.067 (1.033-1.102) |
| Colitis activity | |||||
| Mild | 1.000 | ||||
| Moderate | 2.541 | 1.116 | 2.277 | 0.023 | 2.694 (1.425-3.071) |
| Severe | 2.600 | 1.046 | 2.484 | 0.013 | 3.460 (1.731-4.645) |
| Course of pyoderma gangrenosum | 0.539 | 0.164 | 3.280 | 0.001 | 1.715 (1.242-2.367) |
| Number of chronic diseases | 0.621 | 0.188 | 3.302 | 0.000 | 1.861 (1.287-2.690) |
| Sleep quality | |||||
| Better | 1.000 | ||||
| General | 0.742 | 0.950 | 0.781 | 0.435 | 1.101 (0.326-3.529) |
| Poor | 3.814 | 1.187 | 3.214 | 0.001 | 3.336 (1.429-6.088) |
| Sas score | 0.192 | 0.052 | 3.727 | 0.000 | 1.112 (1.025-1.341) |
Fig.3 Nomogram model ROC curve and the calibration curve. A: ROC curve analysis of the column chart prediction model for predicting the risk of malnutrition in patients. B: Calibration curve analysis of 1000 repeated sampling validations on the model.
Fig.4 Decision curve analysis of the nomogram model for predicting nutritional risk in the patients. The horizontal dashed line (none line) is the extreme case of all negatives, the oblique dashed line (all line) indicates the extreme case of all positives, the uppermost solid line curve (model line) indicates how the established prediction model makes decisions, and when the model line is higher than the all line, it indicates that the model prediction can be clinically beneficial.
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