Valverde-López Francisco, Matas-Cobos Ana M, Alegría-Motte Carlos, Jiménez-Rosales Rita, Úbeda-Muñoz Margarita, Redondo-Cerezo Eduardo
Department of Gastroenterology and Hepatology, "Virgen de las Nieves" University Hospital, Granada, Spain.
J Gastroenterol Hepatol. 2017 Sep;32(9):1649-1656. doi: 10.1111/jgh.13763.
The study aims to assess and compare the predicting ability of some scores and biomarkers in acute pancreatitis.
We prospectively collected data from 269 patients diagnosed of acute pancreatitis, admitted to Virgen de las Nieves University Hospital between June 2010 and June 2012. Blood urea nitrogen (BUN), C-reactive protein, and creatinine were measured on admission and after 48 h, lactate and bedside index for severity acute pancreatitis (BISAP) only on admission and RANSON within the first 48 h. Definitions from 2012 Atlanta Classification were used. Area under the curve (AUC) was calculated for each scoring system for predicting severe acute pancreatitis (SAP), mortality, and intensive care unit (ICU) admission, obtaining optimal cut-off values from the receiver operating characteristic curves.
Eight (3%) patients died, 17 (6.3%) were classified as SAP, and 10 (3.7%) were admitted in ICU. BISAP was the best predictor on admission for SAP, mortality, and ICU admission with an AUC of 0.9 (95% CI 0.83-0.97); 0.97 (95% CI 0.95-0.99); and 0.89 (95% CI 0.79-0.99), respectively. After 48 h, BUN 48 h was the best predictor of SAP (AUC = 0.96 CI: 0.92-0.99); BUN 48 h and BISAP were the best predictors for mortality (AUC = 0.97 CI: 0.95-0.99) and creatinine 48 h for ICU admission (AUC = 0.96 CI: 0.92-0.99). Lactate showed an AUC of 0.79 (CI: 0.71-0.88), 0.87 (CI: 0.78-0.96), and 0.77 (CI: 0.67-0.87) for SAP, mortality, and ICU admission, respectively. All parameters were predictors for SAP, mortality, and ICU admission, but C-reactive protein on admission was only a significant predictor of SAP.
Bedside index for severity acute pancreatitis is a good predictive system for SAP, mortality, and ICU admission, being useful for triaging patients for ICU management. Lactate could be useful for developing new scores.
本研究旨在评估并比较某些评分系统和生物标志物对急性胰腺炎的预测能力。
我们前瞻性收集了2010年6月至2012年6月期间入住比维斯·德拉斯涅韦斯大学医院的269例确诊为急性胰腺炎患者的数据。入院时及48小时后检测血尿素氮（BUN）、C反应蛋白和肌酐，仅在入院时检测乳酸及急性胰腺炎严重程度床边指数（BISAP），并在最初48小时内检测兰森标准（RANSON）。采用2012年亚特兰大分类标准的定义。计算每个评分系统预测重症急性胰腺炎（SAP）、死亡率和重症监护病房（ICU）入住率的曲线下面积（AUC），从受试者工作特征曲线中获得最佳截断值。
8例（3%）患者死亡，17例（6.3%）被分类为SAP，10例（3.7%）入住ICU。BISAP是入院时预测SAP、死亡率和ICU入住率的最佳指标，其AUC分别为0.9（95%CI 0.83 - 0.97）；0.97（95%CI 0.95 - 0.99）；0.89（95%CI 0.79 - 0.99）。48小时后，48小时BUN是预测SAP的最佳指标（AUC = 0.96 CI：0.92 - 0.99）；48小时BUN和BISAP是预测死亡率的最佳指标（AUC = 0.97 CI：0.95 - 0.99），48小时肌酐是预测ICU入住率的最佳指标（AUC = 0.96 CI：0.92 - 0.99）。乳酸对SAP、死亡率和ICU入住率的AUC分别为0.79（CI：0.71 - 0.88）、0.87（CI：0.78 - 0.96）和0.77（CI：0.67 - 0.87）。所有参数均为SAP、死亡率和ICU入住率的预测指标，但入院时C反应蛋白仅是SAP的显著预测指标。
急性胰腺炎严重程度床边指数是预测SAP、死亡率和ICU入住率的良好系统，有助于对患者进行ICU管理的分诊。乳酸可能有助于开发新的评分系统。
