根据修订后的亚特兰大分类法对重症急性胰腺炎预测系统的比较

Comparison of Predictive Systems in Severe Acute Pancreatitis According to the Revised Atlanta Classification.

作者信息

Lee Kyong Joo, Kim Hee Man, Choi Ja Sung, Kim Yoon Jae, Kim Yeon Suk, Cho Jae Hee

机构信息

From the *Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju; †Division of Gastroenterology, Department of Internal Medicine, Myongji Hospital, Goyang; and ‡Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea.

出版信息

Pancreas. 2016 Jan;45(1):46-50. doi: 10.1097/MPA.0000000000000433.

DOI:10.1097/MPA.0000000000000433

PMID:26390419

Abstract

OBJECTIVES

We aimed to compare the prognostic value of various predictors and complex scoring systems for prediction of severe acute pancreatitis (SAP) according to the revised Atlanta classification.

METHODS

C-reactive protein (CRP) and procalcitonin were obtained on admission, and CRP level 24 hours after admission (CRP2) was measured. Various scoring systems including Ranson, Acute Physiology and Chronic Health Examination (APACHE II), the Bedside Index for Severity in Acute Pancreatitis, and Computed Tomography Severity Index (CTSI) were calculated.

RESULTS

There were 146 patients with acute pancreatitis (mean age, 50.6 ± 18.3 years; 63% male), of which 43 patients (29.5%) received a diagnosis of moderately severe AP, and 17 patients (11.6%) received a diagnosis of SAP. In patients with moderately severe acute pancreatitis to SAP, CTSI (odds ratio [OR], 10.46; 95% confidence interval [CI], 4.3-25.43; P < 0.001), APACHE II (OR, 3.87; 95% CI, 1.18-12.64; P = 0.025), and CRP2 (OR, 4.5; 95% CI, 1.53-13.1; P = 0.006) were strongly related to moderately severe acute pancreatitis and SAP. In patients with SAP compared with mild to moderately severe AP, procalcitonin (OR, 4.36; 95% CI, 1.01-18.96; P = 0.049) was the only factor strongly associated with SAP.

CONCLUSIONS

Procalcitonin was the best predictor for patients with SAP; CTSI, APACHE II, and CRP2 were valuable predictors for patients with moderately severe acute pancreatitis and SAP.

摘要

目的

我们旨在根据修订后的亚特兰大分类法比较各种预测指标和复杂评分系统对重症急性胰腺炎（SAP）的预测价值。

方法

入院时检测C反应蛋白（CRP）和降钙素原，并测量入院24小时后的CRP水平（CRP2）。计算包括兰森评分、急性生理与慢性健康状况评分系统（APACHE II）、急性胰腺炎严重程度床边指数和计算机断层扫描严重指数（CTSI）在内的各种评分系统。

结果

共有146例急性胰腺炎患者（平均年龄50.6±18.3岁；63%为男性），其中43例（29.5%）被诊断为中度重症急性胰腺炎，17例（11.6%）被诊断为SAP。在从中度重症急性胰腺炎到SAP的患者中，CTSI（比值比[OR]，10.46；95%置信区间[CI]，4.3 - 25.43；P < 0.001）、APACHE II（OR，3.87；95% CI，1.18 - 12.64；P = 0.025）和CRP2（OR，4.5；95% CI，1.53 - 13.1；P = 0.006）与中度重症急性胰腺炎和SAP密切相关。与轻度至中度重症急性胰腺炎患者相比，SAP患者中降钙素原（OR，4.36；95% CI，1.01 - 18.96；P = 0.049）是唯一与SAP密切相关的因素。