急性胰腺炎严重程度分层的传统评分系统是否足够？
Are traditional scoring systems for severity stratification of acute pancreatitis sufficient?
作者信息
Kiat Thaddaeus Tan Jun, Gunasekaran Sivaraj K, Junnarkar Sameer P, Low Jee Keem, Woon Winston, Shelat Vishal G
机构信息
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
出版信息
Ann Hepatobiliary Pancreat Surg. 2018 May;22(2):105-115. doi: 10.14701/ahbps.2018.22.2.105. Epub 2018 May 30.
BACKGROUNDS/AIMS: Ranson's score (RS) and Glasgow score (GS) have been utilized to stratify the severity of acute pancreatitis (AP). The aim of this study was to validate RS and GS for stratifying the severity of acute pancreatitis and audit our experience of managing AP.
METHODS
We conducted a retrospective review of patients treated for AP from July 2009 to September 2016. Final severity was determined using the revised Atlanta classification. Mortality and complications were analyzed.
RESULTS
From July 2009 to September 2016, a total of 675 patients with a diagnosis of AP were admitted at the hospital. Of them, 669 patients who had sufficient data were analyzed. Their average age±SD was 58.7±17.4 years (range, 21-98 years). There was a male preponderance (n=393, 53.8%). A total of 82 (12.3%) patients had eventual severe pancreatitis. RS demonstrated a sensitivity of 92.7% and a specificity of 52.8% with a positive predictive value (PPV) of 21.5% and a negative predictive value (NPV) of 98.1%. GS demonstrated a sensitivity of 76.8% and a specificity of 69.2% with a PPV of 25.8% and a NPV of 95.5%. For severity prediction, areas under the curve (AUCs) for RS and GS were 0.848 (95% CI: 0.819-0.875) and 0.784 (95% CI: 0.750-0.814), respectively (=0.003). Twelve (1.6%) patients died in the hospital.
CONCLUSIONS
RS has higher sensitivity, NPV and AUC for predicting severity of AP than GS.
背景/目的：兰森评分（RS）和格拉斯哥评分（GS）已被用于对急性胰腺炎（AP）的严重程度进行分层。本研究的目的是验证RS和GS在对急性胰腺炎严重程度进行分层方面的有效性，并总结我们管理AP的经验。
方法
我们对2009年7月至2016年9月期间接受AP治疗的患者进行了回顾性研究。最终严重程度采用修订的亚特兰大分类法确定。分析死亡率和并发症情况。
结果
2009年7月至2016年9月，共有675例诊断为AP的患者入院。其中，对669例有足够数据的患者进行了分析。他们的平均年龄±标准差为58.7±17.4岁（范围21 - 98岁）。男性占优势（n = 393，53.8%）。共有82例（12.3%）患者最终发展为重症胰腺炎。RS的敏感性为92.7%，特异性为52.8%，阳性预测值（PPV）为21.5%，阴性预测值（NPV）为98.1%。GS的敏感性为76.8%，特异性为69.2%，PPV为25.8%，NPV为95.5%。对于严重程度预测，RS和GS的曲线下面积（AUC）分别为0.848（95%CI：0.819 - 0.875）和0.784（95%CI：0.750 - 0.814）（P = 0.003）。12例（1.6%）患者在医院死亡。
结论
在预测AP严重程度方面，RS比GS具有更高的敏感性、NPV和AUC。
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