Department of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.
Eur J Gastroenterol Hepatol. 2013 Jul;25(7):784-9. doi: 10.1097/MEG.0b013e32835fd3f0.
C-reactive protein (CRP) has been used widely in the early risk assessment of patients with acute pancreatitis. This study evaluated the prognostic accuracy of CRP for severe acute pancreatitis (SAP), pancreatic necrosis (PNec), and in-hospital mortality (IM) in terms of the best timing for CRP measurement and the optimal CRP cutoff points.
This was a single-center retrospective cohort study including 379 patients consecutively admitted with acute pancreatitis. CRP determinations at hospital admission, 24, 48, and 72 h after hospital admission were collected. Discriminative and predictive abilities of CRP for SAP, PNec, and IM were assessed by the area under the receiver-operating characteristic curve and the Hosmer-Lemeshow test, respectively. To determine the optimal CRP cutoff points for SAP, PNec, and IM, the minimum P-value approach was used.
In total, 11% of patients had SAP, 20% developed PNec, and 4.2% died. The area under the receiver-operating characteristic curves of CRP at 48 h after hospital admission for SAP, PNec, and IM were 0.81 [95% confidence interval (CI) 0.72-0.90], 0.77 (95% CI 0.68-0.87), and 0.79 (95% CI 0.67-0.91), respectively. The Hosmer-Lemeshow test P-values of CRP at 48 h after hospital admission for SAP, PNec, and IM were 0.82, 0.47, and 0.24, respectively. The optimal CRP at 48 h after hospital admission cutoff points for SAP, PNec, and IM derived were 190, 190, and 170 mg/l, respectively.
CRP at 48 h after hospital admission showed a good prognostic accuracy for SAP, PNec, and IM, better than CRP measured at any other timing. The optimal CRP at 48 h after hospital admission cutoff points for SAP, PNec, and IM varied from 170 to 190 mg/l.
C 反应蛋白（CRP）已广泛应用于急性胰腺炎患者的早期风险评估。本研究旨在评估 CRP 在预测急性胰腺炎严重程度（SAP）、胰腺坏死（PNec）和院内死亡率（IM）方面的预后准确性，探讨 CRP 最佳测量时间和最佳截断值。
这是一项单中心回顾性队列研究，共纳入 379 例连续入院的急性胰腺炎患者。收集入院时、入院后 24、48 和 72 小时的 CRP 检测值。采用受试者工作特征曲线下面积和 Hosmer-Lemeshow 检验评估 CRP 对 SAP、PNec 和 IM 的诊断和预测能力。采用最小 P 值法确定预测 SAP、PNec 和 IM 的最佳 CRP 截断值。
共 11%的患者为 SAP，20%发生 PNec，4.2%死亡。入院后 48 小时 CRP 对 SAP、PNec 和 IM 的受试者工作特征曲线下面积分别为 0.81（95%CI 0.72-0.90）、0.77（95%CI 0.68-0.87）和 0.79（95%CI 0.67-0.91）。入院后 48 小时 CRP 对 SAP、PNec 和 IM 的 Hosmer-Lemeshow 检验 P 值分别为 0.82、0.47 和 0.24。入院后 48 小时 CRP 最佳截断值预测 SAP、PNec 和 IM 的切点分别为 190、190 和 170 mg/L。
入院后 48 小时 CRP 对 SAP、PNec 和 IM 的预后准确性较好，优于其他任何时间点的 CRP。入院后 48 小时 CRP 预测 SAP、PNec 和 IM 的最佳截断值为 170-190 mg/L。
