急性胰腺炎严重进展的预测因素及预测严重结局的新评分
Predictive factors for severe evolution in acute pancreatitis and a new score for predicting a severe outcome.
作者信息
Bota Simona, Sporea Ioan, Sirli Roxana, Popescu Alina, Strain Mihnea, Focsa Mircea, Danila Mirela, Chisevescu Dorina
机构信息
Departments of Gastroenterology and Hepatology (Simona Bota, Ioan Sporea, Roxana Sirli, Alina Popescu, Mihnea Strain, Mirela Danila, Dorina Chisevascu).
Biophysics and Medical Informatics (Mircea Focsa), University of Medicine and Pharmacy Timisoara, Romania.
出版信息
Ann Gastroenterol. 2013;26(2):156-162.
BACKGROUND
Acute pancreatitis (AP) is an acute inflammation of the pancreas with an unpredictable evolution. The aim of this study was to assess the factors associated with severe evolution of AP and to create a new score for predicting a severe outcome.
METHODS
The initial group included 334 patients hospitalized in 2006-2009. The validation group included 195 patients admitted in 2010-2011. AP was classified according to the Atlanta criteria.
RESULTS
In the initial group, C-reactive protein (CRP), creatinine, white blood count, body mass index (BMI), age and male gender were correlated with severe evolution of AP. Using only parameters available in emergency, by multiple regression analysis we obtained in the initial group the following score for predicting severe evolution of AP: Prediction pancreatic severity I score (PPS I score) = -1.038 + 0.119 × creatinine (mg/dL) + 0.012 × BMI (kg/m²) + 0.027xwhite blood count/1000 (cells/mm³) + 0.195 × gender (1-women, 2-men) + 0.005 × age (years). For a cut-off value >0.325, PPS I score had 71.8% accuracy (AUC=0.790) for predicting a severe evolution of AP. In the validation group the accuracy was 71.7%. Since CRP was proven to be a good predictor of severe evolution in AP, we calculated another score, PPS II, obtained using PPS I and CRP: PPS II score = -0.192 + 0.760 x PPS I + 0.003 x CRP (mg/L). For a cut-off value >0.397, PPS II score had 87.1% accuracy (AUROC=0.942) in the initial group and 75.3% accuracy in the validation group for predicting severe AP.
CONCLUSIONS
PPS I and especially PPS II score are accurate predictors of severe outcome in patients with AP.
背景
急性胰腺炎（AP）是一种胰腺的急性炎症，其病情发展难以预测。本研究的目的是评估与AP严重进展相关的因素，并创建一个用于预测严重结局的新评分系统。
方法
初始组包括2006年至2009年住院的334例患者。验证组包括2010年至2011年收治的195例患者。AP根据亚特兰大标准进行分类。
结果
在初始组中，C反应蛋白（CRP）、肌酐、白细胞计数、体重指数（BMI）、年龄和男性性别与AP的严重进展相关。仅使用急诊时可用的参数，通过多元回归分析，我们在初始组中得出了以下用于预测AP严重进展的评分：预测胰腺严重程度I评分（PPS I评分）=-1.038 + 0.119×肌酐（mg/dL）+ 0.012×BMI（kg/m²）+ 0.027×白细胞计数/1000（细胞/mm³）+ 0.195×性别（1-女性，2-男性）+ 0.005×年龄（岁）。对于临界值>0.325，PPS I评分预测AP严重进展的准确率为71.8%（AUC=0.790）。在验证组中，准确率为71.7%。由于CRP被证明是AP严重进展的良好预测指标，我们计算了另一个评分，即PPS II，它是使用PPS I和CRP得出的：PPS II评分=-0.192 + 0.760×PPS I + 0.003×CRP（mg/L）。对于临界值>0.397，PPS II评分在初始组中预测严重AP的准确率为87.1%（AUROC=0.942），在验证组中为75.3%。
结论
PPS I，尤其是PPS II评分是AP患者严重结局的准确预测指标。
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