Talukdar Rupjyoti, Sharma Mithun, Deka Ajit, Teslima Sultana, Dev Goswami Amal, Goswami Arunima, Baro Anup, Nageshwar Reddy D
Department of Gastroenterology, Asian Institute of Gastroenterology, 6-3-661, Somajiguda, Hyderabad, 500 082, India,
Indian J Gastroenterol. 2014 Jul;33(4):316-21. doi: 10.1007/s12664-014-0452-4. Epub 2014 Mar 28.
Several severity predictors have been tested for assessing acute pancreatitis (AP). The recently described harmless acute pancreatitis score (HAPS) could be an ideal predictor for Indian patients at the community level. We validate this system in the current study.
This was a prospective pilot study conducted at a tertiary center from July 2010 to December 2011. Consecutive directly admitted patients over 18 years with a documented first episode of AP were enrolled and followed for at least 12 months after discharge/till death. HAPS was defined as absence of rebound abdominal tenderness, serum creatinine of <2 mg/dL, and hematocrit of <43 for male and <39.6 for female patients at the time of admission; and it was considered positive if the patient fulfilled all three criteria. Study outcomes included total hospital stay, need for intensive care unit (ICU), ICU stay, development of local complications, organ failure, hospital-acquired infections (including infected necrosis), and in-hospital mortality.
There were a total of 103 patients directly admitted with AP during the study period, out of which, 23 were excluded. Forty-seven (58.8 %) patients were positive for HAPS. Of these, 44 (93.6 %) had an eventual non-severe (mild) clinical course with odds ratio 17.6 (95 % CI 4.5-68.3). Sensitivity, specificity, positive and negative predictive value, and receiver operating characteristics area under the curve of HAPS as a predictor of non-severe disease were 76.3 (66.9-86.4), 85.7 (78.0-96.8), 93.8 (88.5-98.6), 56.6 (45.4-73.6), and 84.8 (76.9-92.7) respectively.
This study validated the utility of HAPS for directly admitted patients with AP in India. Large-scale multicenter community-based studies need to be performed.
已经对多种急性胰腺炎（AP）严重程度预测指标进行了测试。最近描述的无害性急性胰腺炎评分（HAPS）可能是印度社区层面患者的理想预测指标。我们在本研究中对该系统进行验证。
这是一项于2010年7月至2011年12月在一家三级中心进行的前瞻性试点研究。纳入连续直接收治的18岁以上首次发作且有记录的AP患者，并在出院后至少随访12个月/直至死亡。HAPS定义为入院时无腹部反跳痛、血清肌酐<2mg/dL、男性血细胞比容<43%且女性<39.6%；若患者满足所有三项标准则认为HAPS为阳性。研究结局包括总住院时间、入住重症监护病房（ICU）的需求、ICU住院时间、局部并发症的发生、器官衰竭、医院获得性感染（包括感染性坏死）以及住院死亡率。
研究期间共有103例直接收治的AP患者，其中23例被排除。47例（58.8%）患者HAPS为阳性。其中，44例（93.6%）最终临床病程为非重度（轻度），比值比为17.6（95%CI 4.5 - 68.3）。作为非重度疾病预测指标的HAPS的敏感性、特异性、阳性和阴性预测值以及曲线下面积分别为76.3（66.9 - 86.4）、85.7（78.0 - 96.8）、93.8（88.5 - 98.6）、56.6（45.4 - 73.6）和84.8（76.9 - 92.7）。
本研究验证了HAPS在印度直接收治的AP患者中的实用性。需要开展大规模多中心基于社区的研究。
