Mok Shaffer R S, Mohan Sachin, Elfant Adam B, Judge Thomas A
From the Division of Gastroenterology and Liver Diseases, Department of Medicine, Cooper University Hospital, Camden, NJ.
Pancreas. 2015 Nov;44(8):1314-9. doi: 10.1097/MPA.0000000000000432.
Severe acute pancreatitis is associated with significant morbidity/mortality; thus, the ability to predict hospital course is imperative. An updated version of the Acute Physiology and Chronic Health Evaluation II (APACHE), APACHE IV, has recently been validated. Unlike other versions, APACHE IV uses hepatobiliary parameters and accounts for multiple comorbid conditions and sedation. The intention of this study was to examine APACHE IV for predicting mortality and secondary outcomes for pancreatitis in a prospective cohort. In addition, we compared APACHE IV to APACHE II, Bedside Index for Severity in Acute Pancreatitis, and Ranson criterion.
We prospectively collected physiologic parameters for each scoring system in 266 patients with severe acute pancreatitis from August 2011 to April 2014. Prognostic value of each score was determined using the area under the receiver operating characteristic curve.
Among 266 patients, 59% were men, 52% were white, and 36.5% had alcohol-induced pancreatitis. Mortality occurred in 15 (5.6%), and an APACHE IV of 44 or greater predicted mortality in 100% of cases. The receiver operating characteristic curve for APACHE IV was 0.93 (confidence interval [CI], 0.88-0.97); APACHE II, 0.87 (CI, 0.80-0.94); Bedside Index for Severity in Acute Pancreatitis, 0.86 (CI, 0.78-0.94); and Ranson criterion, 0.90 (CI, 0.94-0.96).
The APACHE IV is a valid means for predicting mortality and disease-related complications in acute pancreatitis.
重症急性胰腺炎与较高的发病率/死亡率相关；因此，预测病程的能力至关重要。急性生理与慢性健康状况评估II（APACHE）的更新版本APACHE IV最近已得到验证。与其他版本不同，APACHE IV使用肝胆参数，并考虑了多种合并症和镇静情况。本研究旨在在前瞻性队列中检验APACHE IV对胰腺炎死亡率和次要结局的预测能力。此外，我们将APACHE IV与APACHE II、急性胰腺炎严重程度床边指数及兰森标准进行了比较。
我们前瞻性收集了2011年8月至2014年4月期间266例重症急性胰腺炎患者每个评分系统的生理参数。使用受试者工作特征曲线下面积确定每个评分的预后价值。
266例患者中，59%为男性，52%为白人，36.5%患有酒精性胰腺炎。15例（5.6%）死亡，APACHE IV评分44分及以上对100%的病例可预测死亡。APACHE IV的受试者工作特征曲线为0.93（置信区间[CI]，0.88 - 0.97）；APACHE II为0.87（CI，0.80 - 0.94）；急性胰腺炎严重程度床边指数为0.86（CI，0.78 - 0.94）；兰森标准为0.90（CI，0.94 - 0.96）。
APACHE IV是预测急性胰腺炎死亡率和疾病相关并发症的有效方法。
