Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
Division of Pediatric Gastroenterology.
J Pediatr Gastroenterol Nutr. 2019 Mar;68(3):389-393. doi: 10.1097/MPG.0000000000002217.
Acute pancreatitis (AP) is understudied in the pediatric population despite increasing incidence. Although many cases are mild and resolve with supportive care, severe acute pancreatitis (SAP) can be associated with significant morbidity and mortality. There is a lack of pediatric-specific predictive tools to help stratify risk of SAP in children.
A retrospective cohort study of patients with AP or recurrent AP at Cohen Children's Medical Center between 2011 and 2016 was performed. Lipase level and the presence of pediatric systemic inflammatory response syndrome (SIRS) on admission were examined as potential predictors of SAP and length of stay (LOS). A multivariate logistic regression or analysis of covariance was used to conduct the multivariate analysis.
Seventy-nine pediatric patients met inclusion criteria. Approximately 37% (29/79) had SIRS on admission, 22% (17/79) developed SAP, and there were no mortalities. In both the univariate and multivariate models, SIRS was a predictor of SAP. Mean (SD) LOS for patients with SIRS compared with without SIRS was 9.6 ± 8.3 compared with 6.3 ± 6.9 days (P < 0.05). The mean LOS of patients with one or more comorbidity (48%, 38/79) was 10.0 ± 9.5 compared with 5.2 ± 4.0 days (P < 0.01) for those patients without any comorbidities. Only the presence of comorbidities predicted length of time spent nil per os (NPO; P = 0.0022). Patients with comorbidities stayed an average of 5.6 ± 7.6 days NPO, whereas those without comorbidities spent 2.8 ± 2.4 days NPO. Lipase was not predictive of SAP, LOS, or length of time spent NPO.
These results support the use of SIRS as a simple screening tool on admission to identify children at risk for the development of SAP. The presence of any comorbidity was predictive of LOS and length of NPO in the multivariate model. This may reflect that comorbidities prolong pancreatitis or influence disposition planning.
尽管急性胰腺炎（AP）的发病率在增加，但在儿科人群中的研究仍较少。虽然许多病例为轻度且经支持治疗即可缓解，但重度急性胰腺炎（SAP）可能会导致严重的发病率和死亡率。目前缺乏专门针对儿科患者的预测工具，无法帮助对儿童 SAP 的风险进行分层。
对 2011 年至 2016 年期间在科恩儿童医学中心就诊的 AP 或复发性 AP 患儿进行回顾性队列研究。研究人员将入院时的淀粉酶水平和儿科全身炎症反应综合征（SIRS）的存在作为 SAP 和住院时间（LOS）的潜在预测因素进行了检查。使用多变量逻辑回归或协方差分析进行了多变量分析。
79 名儿科患者符合纳入标准。约 37%（29/79）的患儿入院时存在 SIRS，22%（17/79）发展为 SAP，无死亡病例。在单变量和多变量模型中，SIRS 都是 SAP 的预测因素。与无 SIRS 的患儿相比，有 SIRS 的患儿的 LOS 平均值（SD）为 9.6±8.3 天，而无 SIRS 的患儿的 LOS 平均值为 6.3±6.9 天（P＜0.05）。有 1 种或多种合并症（48%，38/79）的患儿的 LOS 平均值为 10.0±9.5 天，而无任何合并症的患儿的 LOS 平均值为 5.2±4.0 天（P＜0.01）。只有合并症的存在预测了禁食时间（P＝0.0022）。有合并症的患儿平均禁食 5.6±7.6 天，而无合并症的患儿平均禁食 2.8±2.4 天。淀粉酶对 SAP、LOS 或禁食时间均无预测作用。
这些结果支持在入院时使用 SIRS 作为一种简单的筛查工具来识别有 SAP 发展风险的患儿。在多变量模型中，任何合并症的存在均与 LOS 和禁食时间相关。这可能反映出合并症会延长胰腺炎的病程或影响处置计划。
