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严重高甘油三酯血症患者急性胰腺炎风险预测模型的外部验证。

EXTERNAL VALIDATION OF A PREDICTIVE MODEL FOR ACUTE PANCREATITIS RISK IN PATIENTS WITH SEVERE HYPERTRIGLYCERIDEMIA.

出版信息

Endocr Pract. 2019 Aug;25(8):817-823. doi: 10.4158/EP-2018-0599. Epub 2019 Apr 23.

Abstract

We previously developed a predictive model to assess the risk of developing acute pancreatitis (AP) in patients with severe hypertriglyceridemia (HTG). In this study, we aimed to externally validate this model. The validation cohort included cross-sectional data between 2013 and 2017. Adult patients (≥18 years old) with triglyceride levels ≥1,000 mg/dL were identified. Based on our previous 4-factor predictive model (age, triglyceride [TG], excessive alcohol use, and gallstone disease), we estimated the probability of developing AP. Model performance was assessed using area under receiver operating characteristic curve (AUROC). In comparison to the original cohort, patients in the validation cohort had more prevalent acute pancreatitis (16.2% versus 9.2%; <.001) and gallstone disease (7.5% versus 2.1%; <.001). Other characteristics were comparable and not statistically significant. The AUROCs were almost identical: 0.8337 versus 0.8336 in the validation and the original cohorts, respectively. In univariable analyses, the highest increase in odds of AP was associated with HTG, followed by gallstones, excessive alcohol use, and younger age. This study externally validates the 4-factor predictive model to estimate the risk of AP in adult patients with severe HTG (TG ≥1,000 mg/dL). Younger age was confirmed to place patients at high risk of AP. The clinical risk categories suggested in this study may be useful to guide treatment options. = acute pancreatitis; = atherosclerotic cardiovascular disease; = area under the receiver operating characteristic curve; = fracture risk assessment tool; = hypertriglyceridemia; = odds ratio; = triglyceride level.

摘要

我们之前开发了一种预测模型,用于评估严重高甘油三酯血症(HTG)患者发生急性胰腺炎(AP)的风险。在本研究中,我们旨在对该模型进行外部验证。验证队列包括 2013 年至 2017 年的横断面数据。确定甘油三酯水平≥1000mg/dL 的成年患者(≥18 岁)。根据我们之前的 4 因素预测模型(年龄、甘油三酯[TG]、过度饮酒和胆结石病),我们估计了发生 AP 的概率。使用接受者操作特征曲线下面积(AUROC)评估模型性能。与原始队列相比,验证队列中的患者更常见急性胰腺炎(16.2%比 9.2%;<0.001)和胆结石病(7.5%比 2.1%;<0.001)。其他特征相似且无统计学意义。AUROCs 几乎相同:验证队列和原始队列分别为 0.8337 和 0.8336。在单变量分析中,AP 发生几率增加最高的是 HTG,其次是胆结石、过度饮酒和年龄较小。本研究对外验证了用于估计严重 HTG(TG≥1000mg/dL)成年患者发生 AP 风险的 4 因素预测模型。年龄较小被证实使患者处于 AP 的高风险中。本研究中提出的临床风险类别可能有助于指导治疗选择。AP = 急性胰腺炎;ASCVD = 动脉粥样硬化性心血管疾病;AUROC = 接受者操作特征曲线下面积;FRAX = 骨折风险评估工具;HTG = 高甘油三酯血症;OR = 比值比;TG = 甘油三酯水平。

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