Valderrama R, Navarro S, Titó L, Mas A, Nadal P, Terés J
Servicio de Gastroenterología, Hospital Clinic i Provincial, Barcelona.
Med Clin (Barc). 1990 Oct 27;95(14):525-8.
The predictive value of eight clinical variables and 20 analytical variables on mortality was retrospectively analyzed in 61 patients with severe acute pancreatitis, fulfilling at least three Ranson criteria, admitted to the ICU between 1977 and 1987. The mean age of the series was 57 +/- 16.6 years. Twenty seven were males and 34 females. The mortality rate was 60%. Univariate analysis demonstrated that the variables with greater predictive value of mortality were: age, days of hospitalization, presence of associated diseases, plasma lactodehydrogenase, more than 10% hematocrit decrease during the first 48 hours, plasma ureic nitrogen on admission and a value greater than 1.8 mmol/l during the first 48 hours, calcemia, arterial oxygen pressure, plasma albumin, and prothrombin time. A logistic regression multivariate analysis disclosed that the variables with independent predictive value of mortality were: age, serum ureic nitrogen, calcemia, arterial oxygen pressure, plasma albumin, and hematocrit decrease after 48 hours. When the patients were grouped according to the presence of less than three, three, four or more than four of these risk factors (being, the average the cutting point) we obtained a good prognostic discriminative power since the mortality in those groups was 0, 30%, 60%, and 100%, respectively.
对1977年至1987年间入住重症监护病房(ICU)的61例重症急性胰腺炎患者进行回顾性分析,这些患者至少符合三项兰森标准,研究八个临床变量和20个分析变量对死亡率的预测价值。该系列患者的平均年龄为57±16.6岁。男性27例,女性34例。死亡率为60%。单因素分析表明,对死亡率具有较高预测价值的变量为:年龄、住院天数、合并疾病的存在、血浆乳酸脱氢酶、最初48小时内血细胞比容下降超过10%、入院时血浆尿素氮以及最初48小时内大于1.8 mmol/l的值、血钙、动脉血氧分压、血浆白蛋白和凝血酶原时间。逻辑回归多因素分析显示,对死亡率具有独立预测价值的变量为:年龄、血清尿素氮、血钙、动脉血氧分压、血浆白蛋白以及48小时后血细胞比容下降。当根据这些危险因素少于三个、三个、四个或多于四个(取平均值作为切点)对患者进行分组时,我们获得了良好的预后判别能力,因为这些组中的死亡率分别为0%、30%、60%和100%。