急性胰腺炎中液体潴留的早期预测指标：一项验证性研究。

Early Predictors of Fluid Sequestration in Acute Pancreatitis: A Validation Study.

作者信息

Sinha Amitasha, Quesada-Vázquez Noé, Faghih Mahya, Afghani Elham, Zaheer Atif, Khashab Mouen A, Lennon Anne Marie, de-Madaria Enriqué, Singh Vikesh K

机构信息

From the *Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD; †Pancreatic Unit, Hospital General Universitario de Alicante, Alicante, Spain; ‡Department of Radiology and Radiological Sciences, and §Pancreatitis Center, Johns Hopkins Medical Institutions, Baltimore, MD.

出版信息

Pancreas. 2016 Feb;45(2):306-10. doi: 10.1097/MPA.0000000000000444.

DOI:10.1097/MPA.0000000000000444

PMID:26418903

Abstract

OBJECTIVES

The primary aim of this retrospective study was to externally validate predictors of increased fluid sequestration at 48 hours (FS⁴⁸) in acute pancreatitis (AP).

METHODS

Patients admitted between January 10 and February 13 with a diagnosis of AP were evaluated. The FS⁴⁸ was calculated as difference between total fluid input and output in the first 48 hours. Predictors of FS⁴⁸, such as young age, alcoholic etiology, hemoconcentration, hyperglycemia, and systemic inflammatory response syndrome (SIRS), and outcomes in AP, such as increased length of stay, acute fluid collection(s), necrosis, and persistent organ failure (POF), were defined in accordance with the previous study. Linear regression analysis was performed to evaluate the association between predictors and outcome.

RESULTS

Two hundred twenty-seven AP patients (mean age, 48 years; 54% men) with a median FS⁴⁸ of 4.2 L were evaluated. Age younger than 40 years, alcoholic etiology, hemoconcentration, and SIRS independently predicted increased FS⁴⁸ (P < 0.05). Increased FS⁴⁸ was associated with persistent SIRS and POF (P < 0.01). There was a significant trend between number of predictors and FS (P < 0.001). The presence of 4 predictors or more was associated with higher rates of persistent SIRS and POF (P < 0.01).

CONCLUSIONS

Our study validated 4 of 5 predictors of increased FS⁴⁸ from the previous study. Presence of 4 predictors or more and increased FS⁴⁸ are both associated with persistent SIRS and POF.

摘要

目的

本回顾性研究的主要目的是对外验证急性胰腺炎（AP）患者48小时液体潴留增加（FS⁴⁸）的预测因素。

方法

对1月10日至2月13日期间收治的诊断为AP的患者进行评估。FS⁴⁸计算为前48小时总液体入量与出量之差。FS⁴⁸的预测因素，如年轻、酒精性病因、血液浓缩、高血糖和全身炎症反应综合征（SIRS），以及AP的结局，如住院时间延长、急性液体积聚、坏死和持续性器官衰竭（POF），均根据先前的研究进行定义。进行线性回归分析以评估预测因素与结局之间的关联。

结果

对227例AP患者（平均年龄48岁；54%为男性）进行了评估，FS⁴⁸中位数为4.2L。年龄小于40岁、酒精性病因、血液浓缩和SIRS独立预测FS⁴⁸增加（P<0.05）。FS⁴⁸增加与持续性SIRS和POF相关（P<0.01）。预测因素数量与FS之间存在显著趋势（P<0.001）。存在4个或更多预测因素与持续性SIRS和POF的发生率较高相关（P<0.01）。