Tee Yu-San, Fang Hsin-Yueh, Kuo I-Ming, Lin Yann-Sheng, Huang Song-Fong, Yu Ming-Chin
Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Kweishan, Taoyuan city, Taiwan Department of Surgery, Xiamen Chang Gung Hospital, Xiamen, Fujian, China.
Medicine (Baltimore). 2018 Feb;97(7):e9654. doi: 10.1097/MD.0000000000009654.
Acute severe pancreatitis caused high mortality, and several scoring systems for predicting mortality are available. We evaluated the effectiveness of serial measurement of several scoring systems in patients with acute severe pancreatitis.We retrospectively obtained serial measurements of Ranson, Acute Physiology and Chronic Health Assessment (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores of 159 patients with acute severe pancreatitis.The overall mortality rate was 20%, and early mortality (in the first 2 weeks) occurred in 10 (7.4%) patients, while late mortality occurred in 17 (12.6%).All scoring systems were reliable for predicting overall and intensive care unit mortality, while the SOFA score on day 7 presented the largest area under the receiver operator characteristic (ROC) curve (0.858, SE 0.055). Changes in scores over time were evaluated for predicting the progression of organ failure, and the change in SOFA score on hospital day 7 or no interval change in SOFA score was associated with higher mortality rates.APACHE II and SOFA scores are both sensitive for predicting mortality in acute pancreatitis. The serial SOFA scores showed reliable for predicting mortality. Hospital day 7 is a reasonable time for SOFA score reassessment to predict late mortality in acute severe pancreatitis.
急性重症胰腺炎导致的死亡率很高,目前有几种用于预测死亡率的评分系统。我们评估了对急性重症胰腺炎患者连续测量几种评分系统的有效性。我们回顾性地获取了159例急性重症胰腺炎患者的兰森(Ranson)评分、急性生理与慢性健康状况评估(APACHE)II评分以及序贯器官衰竭评估(SOFA)评分的连续测量值。总体死亡率为20%,早期死亡(前2周内)发生在10例(7.4%)患者中,而晚期死亡发生在17例(12.6%)患者中。所有评分系统在预测总体死亡率和重症监护病房死亡率方面都是可靠的,而第7天的SOFA评分在受试者工作特征(ROC)曲线下的面积最大(0.858,标准误0.055)。评估了随时间变化的评分以预测器官衰竭的进展,第7天SOFA评分的变化或SOFA评分无间隔变化与较高的死亡率相关。APACHE II评分和SOFA评分在预测急性胰腺炎死亡率方面均很敏感。连续的SOFA评分在预测死亡率方面显示出可靠性。第7天是对SOFA评分进行重新评估以预测急性重症胰腺炎晚期死亡率的合理时间。