Jin Zhouxiang, Xu Lubai, Wang Xiangyu, Yang Dinghua
Department of Hepatobiliary Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (mainland).
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China (mainland).
Med Sci Monit. 2017 Feb 26;23:1026-1032. doi: 10.12659/msm.900383.
BACKGROUND The aim of the present study was to investigate risk factors for developing more severe pancreatitis, including moderately severe (MSAP) and severe acute pancreatitis (SAP), in patients admitted with mild acute pancreatitis (MAP). MATERIAL AND METHODS Patients admitted with MAP to our hospital from March 2013 to May 2016 were included and prospectively evaluated. Possible risk factors for developing MSAP or SAP were age, blood glucose level on admission, etiology, sex, Ranson score, amylase level, Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores, C-reactive protein (CRP) level, serum calcium level, visceral fat area (VFA), body mass index (BMI), whether this was the first episode of AP, and method of administration of octreotide. The effects of variables for developing MSAP or SAP were evaluated using univariate and multivariate logistic regression models. Mortality, hospital duration, and rate of ICU transfer of patients were compared between patients who developed MSAP or SAP and patients who did not. RESULTS A total of 602 patients admitted with MAP were recruited into this study (256 men and 346 women). Seventy-four patients (12.3%) developed MSAP or SAP. According to univariate logistic regression analyses, the results indicated that there were 5 significant differences between patients who developed MSAP or SAP and those who did not: VFA (>100 cm²) (p=0.003), BMI (≥25 kg/m²) (p=0.001), Ranson score(p=0.004), APACHE-II (≥5) (p=0.001), and blood glucose level on admission (>11.1 mmol/L) (p=0.040). Further multivariate logistic regression analyses revealed that BMI (≥25 kg/m²) (p=0.005), APACHE-II (≥5) (p=0.001), and blood glucose level on admission (>11.1 mmol/L) (p=0.004) were independent risk factors for developing MSAP or SAP in patients admitted with MAP. Moreover, patients who developed MSAP or SAP had a mortality rate of 5.4%. CONCLUSIONS Significant risk factors for developing MSAP or SAP in patients admitted with MAP included BMI (≥25 kg/m²), APACHE-II (≥5), and blood glucose level on admission (>11.1 mmol/L). These factors should be used in the prediction of more severe pancreatitis in patients admitted with MAP.
背景 本研究旨在调查轻度急性胰腺炎（MAP）患者发生更严重胰腺炎的危险因素，包括中度重症胰腺炎（MSAP）和重症急性胰腺炎（SAP）。 材料与方法 纳入2013年3月至2016年5月在我院住院的MAP患者并进行前瞻性评估。发生MSAP或SAP的可能危险因素有年龄、入院时血糖水平、病因、性别、兰森评分、淀粉酶水平、急性生理与慢性健康状况评分系统II（APACHE-II）评分、C反应蛋白（CRP）水平、血清钙水平、内脏脂肪面积（VFA）、体重指数（BMI）、是否为首次发生急性胰腺炎（AP）以及奥曲肽的给药方式。使用单因素和多因素逻辑回归模型评估发生MSAP或SAP的变量的影响。比较发生MSAP或SAP的患者与未发生者之间的死亡率、住院时间和重症监护病房（ICU）转入率。 结果 本研究共纳入602例MAP患者（男性256例，女性346例）。74例患者（12.3%）发生MSAP或SAP。根据单因素逻辑回归分析，结果表明发生MSAP或SAP的患者与未发生者之间存在5个显著差异：VFA（>100 cm²）（p=0.003）、BMI（≥25 kg/m²）（p=0.001）、兰森评分（p=0.004）、APACHE-II（≥5）（p=0.001）以及入院时血糖水平（>11.1 mmol/L）（p=0.040）。进一步的多因素逻辑回归分析显示，BMI（≥25 kg/m²）（p=0.005）、APACHE-II（≥5）（p=0.001）以及入院时血糖水平（>11.1 mmol/L）（p=0.004）是MAP患者发生MSAP或SAP的独立危险因素。此外，发生MSAP或SAP的患者死亡率为5.4%。 结论 MAP患者发生MSAP或SAP的显著危险因素包括BMI（≥25 kg/m²）、APACHE-II（≥5）以及入院时血糖水平（>11.1 mmol/L）。这些因素应用于预测MAP患者发生更严重胰腺炎。
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