{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T22:48:39Z","timestamp":1780440519833,"version":"3.54.1"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Intestinal barrier dysfunction (IBDF) can lead to systemic inflammatory response syndrome and multiple organ failure, severely jeopardizing patient health. Preventing the occurrence of IBDF is crucial, but effective prediction and assessment tools are currently lacking. In this study, we aimed to construct and validate a nomogram for early prediction of the risk of IBDF in patients undergoing major abdominal surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 684 patients undergoing major abdominal surgery were prospectively included, among whom patients from the Second Affiliated Hospital of Kunming Medical University and Kunming Haikou Hospital were assigned to the training (<jats:italic>n<\/jats:italic> = 480) and external validation (<jats:italic>n<\/jats:italic> = 204) cohorts, respectively. Univariate and multivariate logistic regression analyses were performed to screen for independent predictors of IBDF. Based on these factors, the nomogram was constructed to predict IBDF occurrence. The area under the receiver operating characteristic curve (AUC), calibration plot, decision curve analysis (DCA), and clinical impact curve (CIC) were used to evaluate the predictive performance and clinical utility of the model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the training and validation cohorts, 28.3 and 26.9% of patients experienced IBDF, respectively. The multivariate logistic regression analysis showed that surgical method, operative time, blood loss, infusion volume, albumin, interleukin-6, neutrophil-to-lymphocyte ratio, and opioid use were independent predictors of IBDF. The AUC of the IBDF nomogram based on these eight variables was 0.946 (95% CI: 0.921\u20130.970) and 0.944 (95% CI: 0.907\u20130.981) in the training and validation cohorts, respectively. The calibration curves showed good consistency, and the DCA and CIC results showed that the constructed model has good clinical applicability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We established and validated an IBDF-nomogram for the first time to predict the risk of IBDF in patients after major abdominal surgery. This model provides a practical tool for clinicians to identify high-risk patients with IBDF in the early stage, which may have significance in guiding clinical treatment decisions.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1606443","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T15:43:16Z","timestamp":1755790996000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Development and validation of a nomogram for predicting the risk of intestinal barrier dysfunction in patients after major abdominal surgery: a prospective cohort study"],"prefix":"10.3389","volume":"12","author":[{"given":"Qinghua","family":"Zou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruotian","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunfang","family":"Dong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiming","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoyun","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaochuan","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manqing","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingwen","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lixing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaiwen","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyuan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yichen","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanpei","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/j.ebiom.2019.02.055","article-title":"STING-mediated intestinal barrier dysfunction contributes to lethal sepsis.","volume":"41","author":"Hu","year":"2019","journal-title":"EBioMedicine"},{"key":"B2","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.ccc.2015.11.004","article-title":"The gut as the motor of multiple organ dysfunction in critical illness.","volume":"32","author":"Klingensmith","year":"2016","journal-title":"Crit Care Clin"},{"key":"B3","doi-asserted-by":"publisher","first-page":"106831","DOI":"10.1016\/j.isci.2023.106831","article-title":"Integrative analysis reveals marker genes for intestinal mucosa barrier repairing in clinical patients.","volume":"26","author":"Zhao","year":"2023","journal-title":"iScience."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1933","DOI":"10.3390\/genes13111933","article-title":"Circulating mtDNA and impaired intestinal barrier after gastrointestinal surgery are correlated with postoperative SIRS.","volume":"13","author":"Kong","year":"2022","journal-title":"Genes"},{"key":"B5","doi-asserted-by":"publisher","first-page":"12836","DOI":"10.3390\/ijerph182312836","article-title":"Intestinal barrier in human health and disease.","volume":"18","author":"Di Tommaso","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B6","doi-asserted-by":"publisher","first-page":"388","DOI":"10.21037\/atm.2019.07.102","article-title":"Screening and combining serum biomarkers to improve their diagnostic performance in the detection of intestinal barrier dysfunction in patients after major abdominal surgery.","volume":"7","author":"Kong","year":"2019","journal-title":"Ann Transl Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.pan.2022.11.011","article-title":"Acute pancreatitis is characterized by generalized intestinal barrier dysfunction in early stage.","volume":"23","author":"Agarwal","year":"2023","journal-title":"Pancreatology"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e0294918","DOI":"10.1371\/journal.pone.0294918","article-title":"Characterisation of biomarkers of intestinal barrier function in response to a high fat\/high carbohydrate meal and corticotropin releasing hormone.","volume":"19","author":"Mogilevski","year":"2024","journal-title":"PLoS One"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.6061\/clinics\/2013(07)23","article-title":"Temporal relationship of serum markers and tissue damage during acute intestinal ischemia\/reperfusion.","volume":"68","author":"Guzm\u00e1n-de la Garza","year":"2013","journal-title":"Clinics."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1376","DOI":"10.1126\/science.aar3318","article-title":"Hyperglycemia drives intestinal barrier dysfunction and risk for enteric infection.","volume":"359","author":"Thaiss","year":"2018","journal-title":"Science"},{"key":"B11","doi-asserted-by":"publisher","first-page":"2288","DOI":"10.3390\/nu16142288","article-title":"Parenteral nutrition, inflammatory bowel disease, and gut barrier: an intricate plot.","volume":"16","author":"Covello","year":"2024","journal-title":"Nutrients"},{"key":"B12","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s10020-022-00556-8","article-title":"Inhibition of platelet activation suppresses reactive enteric glia and mitigates intestinal barrier dysfunction during sepsis.","volume":"28","author":"Cheng","year":"2022","journal-title":"Mol Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/j.ijsu.2019.11.002","article-title":"STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery.","volume":"72","author":"Agha","year":"2019","journal-title":"Int J Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"znad355","DOI":"10.1093\/bjs\/znad355","article-title":"Novel approach to defining major abdominal surgery.","volume":"111","author":"Courtney","year":"2024","journal-title":"Br J Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"m441","DOI":"10.1136\/bmj.m441","article-title":"Calculating the sample size required for developing a clinical prediction model.","volume":"368","author":"Riley","year":"2020","journal-title":"BMJ"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.1097\/CCM.0b013e31828a3dba","article-title":"Bacteremia in patients with acute pancreatitis as revealed by 16S ribosomal RNA gene-based techniques.","volume":"41","author":"Li","year":"2013","journal-title":"Crit Care Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1007\/s10620-014-3381-2","article-title":"Bacterial translocation and endotoxemia after pringle maneuver in cirrhotic rats.","volume":"60","author":"Su","year":"2015","journal-title":"Dig Dis Sci"},{"key":"B18","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1007\/s10126-021-10078-9","article-title":"Evaluation of Sensitivity and Cost-Effectiveness of Molecular Methods for the Co-detection of Waterborne Pathogens in India.","volume":"23","author":"Ambili","year":"2021","journal-title":"Mar Biotechnol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2357","DOI":"10.1007\/s00464-013-2788-8","article-title":"Oxidative stress markers in laparoscopic versus open colectomy for cancer: a double-blind randomized study.","volume":"27","author":"Pappas-Gogos","year":"2013","journal-title":"Surg Endosc"},{"key":"B20","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1001\/archsurg.2012.31","article-title":"Effect of laparoscopy on the risk of small-bowel obstruction: a population-based register study.","volume":"147","author":"Angenete","year":"2012","journal-title":"Arch Surg"},{"key":"B21","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/S0140-6736(19)32636-4","article-title":"Adhesion-related readmissions after open and laparoscopic surgery: a retrospective cohort study (SCAR update).","volume":"395","author":"Krielen","year":"2020","journal-title":"Lancet"},{"key":"B22","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1016\/j.surg.2020.11.004","article-title":"Beta-1 blocker reduces inflammation and preserves intestinal barrier function after open abdominal surgery.","volume":"169","author":"Tan","year":"2021","journal-title":"Surgery"},{"key":"B23","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1039\/d3fo03954d","article-title":"Wheat peptides inhibit the activation of MAPK and NF-\u03baB inflammatory pathways and maintain epithelial barrier integrity in NSAID-induced intestinal epithelial injury.","volume":"15","author":"Feng","year":"2024","journal-title":"Food Funct"},{"key":"B24","first-page":"445","article-title":"Integrity of gut mucosa during anaesthesia in major abdominal surgery.","volume":"35","author":"Gulam","year":"2011","journal-title":"Coll Antropol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1002\/cphy.c200016","article-title":"Physiology of human hemorrhage and compensation.","volume":"11","author":"Convertino","year":"2021","journal-title":"Compr Physiol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1213\/ANE.0b013e318253631c","article-title":"Dexmedetomidine prevents alterations of intestinal microcirculation that are induced by surgical stress and pain in a novel rat model.","volume":"115","author":"Yeh","year":"2012","journal-title":"Anesth Analg"},{"key":"B27","first-page":"559","article-title":"Effect of stroke volume variation guided fluid therapy on intestinal barrier function in patients undergoing radical gastrectomy.","volume":"29","author":"Zhang","year":"2022","journal-title":"Chin J Clin Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"110425","DOI":"10.1016\/j.intimp.2023.110425","article-title":"Succinate pretreatment attenuates intestinal ischemia-reperfusion injury by inhibiting necroptosis and inflammation via upregulating Klf4.","volume":"120","author":"Cao","year":"2023","journal-title":"Int Immunopharmacol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"16190","DOI":"10.1038\/s41598-017-16366-6","article-title":"Ischemic postconditioning protects against intestinal ischemia\/reperfusion injury via the HIF-1\u03b1\/miR-21 Axis.","volume":"7","author":"Jia","year":"2017","journal-title":"Sci Rep"},{"key":"B30","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1097\/SHK.0000000000002287","article-title":"Effects of hyperbaric oxygen therapy on intestinal ischemia-reperfusion and its mechanism.","volume":"61","author":"Song","year":"2024","journal-title":"Shock."},{"key":"B31","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1016\/j.chom.2018.03.004","article-title":"Listeria adhesion protein induces intestinal epithelial barrier dysfunction for bacterial translocation.","volume":"23","author":"Drolia","year":"2018","journal-title":"Cell Host Microbe."},{"key":"B32","doi-asserted-by":"publisher","first-page":"111502","DOI":"10.1016\/j.foodres.2022.111502","article-title":"Taxifolin ameliorates lipopolysaccharide-induced intestinal epithelial barrier dysfunction via attenuating NF-kappa B\/MLCK pathway in a Caco-2 cell monolayer model.","volume":"158","author":"Gong","year":"2022","journal-title":"Food Res Int"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.1111\/1756-185X.13157","article-title":"Characterization of neutrophil-to-lymphocyte ratio as a measure of inflammation in rheumatoid arthritis.","volume":"20","author":"Chandrashekara","year":"2017","journal-title":"Int J Rheum Dis"},{"key":"B34","doi-asserted-by":"publisher","first-page":"275","DOI":"10.3390\/biomedicines8080275","article-title":"Neutrophil extracellular traps impair intestinal barrier function during experimental colitis.","volume":"8","author":"Lin","year":"2020","journal-title":"Biomedicines"},{"key":"B35","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1111\/codi.12008","article-title":"Preoperative neutrophil to lymphocyte ratio >5 is a prognostic factor for recurrent colorectal cancer.","volume":"15","author":"Mallappa","year":"2013","journal-title":"Colorectal Dis"},{"key":"B36","doi-asserted-by":"publisher","first-page":"237","DOI":"10.2147\/JIR.S292544","article-title":"Clinical implications of intestinal barrier damage in psoriasis.","volume":"14","author":"Sikora","year":"2021","journal-title":"J Inflamm Res"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.14744\/tjtes.2022.46944","article-title":"The role of neutrophil-to-lymphocyte ratio in predicting disease progression and emergency surgery indication in benign intestinal obstructions.","volume":"28","author":"Ta\u015fc\u0131","year":"2022","journal-title":"Ulus Travma Acil Cerrahi Derg."},{"key":"B38","doi-asserted-by":"publisher","first-page":"407","DOI":"10.3390\/biom13030407","article-title":"Alterations in the plasma protein expression pattern in congenital analbuminemia-a systematic review.","volume":"13","author":"Foster","year":"2023","journal-title":"Biomolecules"},{"key":"B39","doi-asserted-by":"publisher","first-page":"e12829","DOI":"10.1111\/micc.12829","article-title":"The association between hypoalbuminemia and microcirculation, endothelium, and glycocalyx disorders in children with sepsis.","volume":"30","author":"Fern\u00e1ndez-Sarmiento","year":"2023","journal-title":"Microcirculation"},{"key":"B40","doi-asserted-by":"publisher","first-page":"963","DOI":"10.3390\/ani14060963","article-title":"Evaluation of intestinal barrier dysfunction with serum iohexol concentration in dogs with acute hemorrhagic diarrhea syndrome.","volume":"14","author":"Reisinger","year":"2024","journal-title":"Animals"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1097","DOI":"10.1111\/ans.17673","article-title":"The net parenchymal thickness predicts pancreatic fistula after pancreaticoduodenectomy: a retrospective cohort study of objective data.","volume":"92","author":"Xu","year":"2022","journal-title":"ANZ J Surg"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1002\/ibd.21842","article-title":"Preoperative hypoalbuminemia is associated with adverse outcomes after ileoanal pouch surgery.","volume":"18","author":"Nisar","year":"2012","journal-title":"Inflamm Bowel Dis"},{"key":"B43","doi-asserted-by":"publisher","first-page":"G79","DOI":"10.1152\/ajpgi.00085.2019","article-title":"Clathrin and GRK2\/3 inhibitors block \u03b4-opioid receptor internalization in myenteric neurons and inhibit neuromuscular transmission in the mouse colon.","volume":"317","author":"DiCello","year":"2019","journal-title":"Am J Physiol Gastrointest Liver Physiol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1418","DOI":"10.1038\/mi.2016.9","article-title":"Opioid-induced gut microbial disruption and bile dysregulation leads to gut barrier compromise and sustained systemic inflammation.","volume":"9","author":"Banerjee","year":"2016","journal-title":"Mucosal Immunol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1080\/19490976.2019.1629237","article-title":"Opioid use potentiates the virulence of hospital-acquired infection, increases systemic bacterial dissemination and exacerbates gut dysbiosis in a murine model of Citrobacter rodentium infection.","volume":"11","author":"Wang","year":"2020","journal-title":"Gut Microbes"},{"key":"B46","doi-asserted-by":"publisher","first-page":"2999","DOI":"10.3389\/fimmu.2019.02999","article-title":"Opioids impair intestinal epithelial repair in HIV-infected humanized mice.","volume":"10","author":"Meng","year":"2020","journal-title":"Front Immunol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1606443\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T15:43:17Z","timestamp":1755790997000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1606443\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,21]]},"references-count":46,"alternative-id":["10.3389\/fmed.2025.1606443"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1606443","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,21]]},"article-number":"1606443"}}