Division of Gastroenterology, Center for Pancreatic Disease, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Pancreas. 2010 Jul;39(5):572-6. doi: 10.1097/MPA.0b013e3181ccc9d2.
Studies evaluating hemoconcentration as a marker of necrosis in acute pancreatitis have reached different conclusions. The aim of this study was to determine the impact of transfer status on the accuracy of hemoconcentration for the prediction of pancreatic necrosis.
We prospectively enrolled 339 patients in an observational cohort study from June 2005 to December 2007. Univariate and multivariate logistic regression analyses were used to evaluate the impact of transfer status on the relationship between hemoconcentration and necrosis. Accuracy for prediction of necrosis was measured by the area under the receiver operating characteristic curve.
Hemoconcentration was associated with increased risk of necrosis only among transferred patients (odds ratio [95% confidence limits], 3.6 [1.2, 10.8]). The area under the receiver operating characteristic curve for admission hematocrit for prediction of necrosis was 0.78 among the transferred patients versus 0.55 among those with primary admissions (chi2, P < 0.0001). Transferred patients had greater initial severity (median bedside index of severity in acute pancreatitis, 2 vs 1; P < 0.0001), were more likely to have hemoconcentration (44% vs 18%; chi2, P < 0.0001), and experienced increased necrosis (37.5% vs 3.6%; chi2, P < 0.0001) compared with primary admissions. After adjusting for sex, disease severity, fluid resuscitation, and transfer status, hemoconcentration was not associated with necrosis (Wald chi2, P = 0.14).
Transfer status is a confounder in the relationship between hemoconcentration and pancreatic necrosis.
评估血浓缩作为急性胰腺炎坏死标志物的研究得出的结论不尽相同。本研究旨在确定转院状态对血浓缩预测胰腺坏死准确性的影响。
我们前瞻性地纳入了 2005 年 6 月至 2007 年 12 月的观察性队列研究中的 339 例患者。采用单变量和多变量逻辑回归分析评估转院状态对血浓缩与坏死之间关系的影响。通过受试者工作特征曲线下面积评估坏死预测的准确性。
只有在转院患者中，血浓缩与坏死风险增加相关（比值比[95%置信区间]，3.6[1.2, 10.8]）。转院患者入院时血细胞比容预测坏死的受试者工作特征曲线下面积为 0.78，而首诊患者为 0.55（卡方，P<0.0001）。转院患者初始严重程度更高（床边急性胰腺炎严重程度指数中位数，2 比 1；P<0.0001），更可能出现血浓缩（44%比 18%；卡方，P<0.0001），且坏死发生率更高（37.5%比 3.6%；卡方，P<0.0001）。校正性别、疾病严重程度、液体复苏和转院状态后，血浓缩与坏死无关（Wald 卡方，P=0.14）。
转院状态是血浓缩与胰腺坏死之间关系的混杂因素。
