Nomogram for Predicting Pancreatic Pseudocyst in Hypertriglyceridemic Acute Pancreatitis: A Retrospective Cohort Study

Purpose: Pancreatic pseudocyst (PPC) is a relatively common local complication of hypertriglyceridemic acute pancreatitis (HTG-AP), frequently associated with prolonged hospital stay and potentially increased need for minimally invasive intervention. However, there is currently no established PPC prediction tool based on early admission indicators for HTG-AP patients. Patients and Methods: In this retrospective study, 684 HTG-AP patients from January 2017 to January 2025 were included. All the patients were divided into training and validation sets in a 7:3 ratio. The least absolute shrinkage and selection operator regression was utilized for preliminary screening of predictive factors in the training set. Then, multivariate logistic regression was applied to identify potential factors for nomogram construction. Results: A total of 684 patients were included, with an overall PPC incidence of 15.7%. The model incorporated three predictors: systemic inflammatory response syndrome (SIRS) (odds ratio OR = 2.263, 95% confidence interval CI: 1.283– 3.991, p = 0.005), C-reactive protein (CRP) (OR = 1.019, 95% CI: 1.013– 1.026, p < 0.001), and lactate (OR = 3.219, 95% CI: 2.182– 4.749, p < 0.001). The nomogram showed good discrimination, with an area under the curve (AUC) of 0.816 (95% CI: 0.759– 0.869) in the training cohort and 0.760 (95% CI: 0.658– 0.854) in the validation cohort. Calibration performance was acceptable, with calibration slopes of 1.000 and 0.773 and Brier scores of 0.100 and 0.108 in the training and validation cohorts, respectively. Decision curve analysis further demonstrated positive net clinical benefit in both cohorts. Conclusion: SIRS, CRP, and lactate may be associated with the occurrence of PPC in patients with HTG-AP and may have value for early risk assessment. We developed a nomogram for PPC risk stratification in this population; however, further external validation is needed to confirm its generalizability and potential clinical utility. Keywords: hypertriglyceridemic acute pancreatitis, pancreatic pseudocyst, risk factor, nomogram