基于证据的严重急性胰腺炎器官衰竭预测方案。

An evidence-based proposal for predicting organ failure in severe acute pancreatitis.

机构信息

From the *Department of General Surgery, †Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Colorectal Disease, and ‡Department of Ultrasonography, the Fourth Center Hospital; §Radiological Department in General Hospital, ∥Center for Pancreatic Disease, Division of Gastroenterology, Hepatology and Colorectal disease, Department of Medicine, ¶Center of Evidence-Based Medicine, Department of Statistics and Epidemiology, College of Public Health, and #Department of Neuroendocrine and Metabolism Disease, the Metabolism Medicine Hospital, Tianjin Medical University; **Department of Hematology Medicine, and ††Center for Severe Pancreatic Disease, Division of Intensive Care Unit, the Fourth Center Hospital; ‡‡Center for Hematic Disease Laboratory, Tianjin Medical University, Tianjin; and §§Department of International Herald Leader, Xin Hua News Agency, Beijing, China.

出版信息

Pancreas. 2013 Nov;42(8):1255-61. doi: 10.1097/MPA.0b013e3182a5d6a7.

DOI:10.1097/MPA.0b013e3182a5d6a7

PMID:24152952

Abstract

OBJECTIVES

Early, efficient, and accurate evaluation for organ failure is an important step for improving outcome in severe acute pancreatitis (SAP). We aim to develop a method that can early, efficiently, and accurately evaluate the in-hospital organ failure in patients with SAP.

METHODS

Using multivariate logistic regression analysis, the associative factors for in-hospital organ failure were evaluated retrospectively from conventional data obtained from 393 patients with SAP from 2000 to 2012. In classification and regression tree analysis, a new clinical scoring system was developed for the evaluation of in-hospital organ failure in SAP. We also compared the accuracy of our new scoring system with multiple organ dysfunction score and Acute Physiology and Chronic Health Examination II score by the receiver operating characteristic curve.

RESULTS

Laboratory results revealed serum calcium level greater than or equal to 1.84 mmol/L, serum creatinine level greater than or equal to 110 µmol/L, age greater than or equal to 72 years, activated partial thromboplastin time less than or equal to 30.95 seconds, and Balthazar computed tomography score greater than or equal to 7 (CCAAB) score system, each contributed 1 point for the prediction of organ failure. The area under the curve of the CCAAB score system was similar to multiple organ dysfunction scores and Acute Physiology and Chronic Health Examination II scores.

CONCLUSIONS

The new scoring system CCAAB is an efficient and accurate method for the early evaluation of patients with SAP for in-hospital organ failure.

摘要

目的

早期、高效、准确地评估器官衰竭是改善重症急性胰腺炎（SAP）患者预后的重要步骤。我们旨在开发一种方法，能够早期、高效、准确地评估 SAP 患者住院期间的器官衰竭。

方法

采用多变量逻辑回归分析，回顾性评估了 2000 年至 2012 年间 393 例 SAP 患者的常规数据中与住院期间器官衰竭相关的因素。在分类回归树分析中，为 SAP 患者住院期间器官衰竭的评估制定了新的临床评分系统。我们还通过接受者操作特征曲线比较了我们的新评分系统与多器官功能障碍评分和急性生理与慢性健康评估 II 评分的准确性。

结果

实验室结果显示血清钙水平≥1.84mmol/L、血清肌酐水平≥110μmol/L、年龄≥72 岁、活化部分凝血活酶时间≤30.95 秒和 Balthazar CT 评分≥7（CCAAB）评分系统，每个因素为器官衰竭的预测贡献 1 分。CCAAB 评分系统的曲线下面积与多器官功能障碍评分和急性生理与慢性健康评估 II 评分相似。