Wu Bechien U, Bakker Olaf J, Papachristou Georgios I, Besselink Marc G, Repas Kathryn, van Santvoort Hjalmar C, Muddana Venkata, Singh Vikesh K, Whitcomb David C, Gooszen Hein G, Banks Peter A
Center for Pancreatic Disease, Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Arch Intern Med. 2011 Apr 11;171(7):669-76. doi: 10.1001/archinternmed.2011.126.
Objective assessment of acute pancreatitis (AP) is critical to help guide resuscitation efforts. Herein we (1) validate serial blood urea nitrogen (BUN) measurement for early prediction of mortality and (2) develop an objective BUN-based approach to early assessment in AP.
We performed a secondary analysis of 3 prospective AP cohort studies: Brigham and Women's Hospital (BWH), June 2005 through May 2009; the Dutch Pancreatitis Study Group (DPSG), March 2004 through March 2007; and the University of Pittsburgh Medical Center (UPMC), June 2003 through September 2007. Meta-analysis and stratified multivariate logistic regression adjusted for age, sex, and creatinine levels were calculated to determine risk of mortality associated with elevated BUN level at admission and rise in BUN level at 24 hours. The accuracy of the BUN measurements was determined by area under the receiver operating characteristic curve (AUC) analysis compared with serum creatinine measurement and APACHE II score. A BUN-based assessment algorithm was derived on BWH data and validated on the DPSG and UPMC cohorts.
A total of 1043 AP cases were included in analysis. In pooled analysis, a BUN level of 20 mg/dL or higher was associated with an odds ratio (OR) of 4.6 (95% confidence interval [CI], 2.5-8.3) for mortality. Any rise in BUN level at 24 hours was associated with an OR of 4.3 (95% CI, 2.3-7.9) for death. Accuracy of serial BUN measurement (AUC, 0.82-0.91) was comparable to that of the APACHE II score (AUC, 0.72-0.92) in each of the cohorts. A BUN-based assessment algorithm identified patients at increased risk for mortality during the initial 24 hours of hospitalization.
We have confirmed the accuracy of BUN measurement for early prediction of mortality in AP and developed an algorithm that may assist physicians in their early resuscitation efforts.
急性胰腺炎（AP）的客观评估对于指导复苏工作至关重要。在此，我们（1）验证连续测定血尿素氮（BUN）用于早期预测死亡率的准确性，以及（2）开发一种基于BUN的客观方法用于AP的早期评估。
我们对3项前瞻性AP队列研究进行了二次分析：布莱根妇女医院（BWH），2005年6月至2009年5月；荷兰胰腺炎研究组（DPSG），2004年3月至2007年3月；以及匹兹堡大学医学中心（UPMC），2003年6月至2007年9月。计算了年龄、性别和肌酐水平校正后的荟萃分析和分层多变量逻辑回归，以确定入院时BUN水平升高和24小时时BUN水平升高与死亡风险的相关性。通过与血清肌酐测量值和急性生理与慢性健康状况评分系统II（APACHE II）评分比较，采用受试者操作特征曲线（AUC）分析来确定BUN测量的准确性。基于BWH的数据推导了一种基于BUN的评估算法，并在DPSG和UPMC队列中进行了验证。
共有1043例AP病例纳入分析。在汇总分析中，BUN水平≥20 mg/dL与死亡的比值比（OR）为4.6（95%置信区间[CI]，2.5 - 8.3）相关。24小时时BUN水平的任何升高与死亡的OR为4.3（95% CI，2.3 - 7.9）相关。在每个队列中，连续BUN测量的准确性（AUC，0.82 - 0.91）与APACHE II评分（AUC，0.72 - 0.92）相当。一种基于BUN的评估算法可识别住院最初24小时内死亡风险增加的患者。
我们已证实BUN测量用于早期预测AP死亡率的准确性，并开发了一种算法，可协助医生进行早期复苏工作。
