急性胰腺炎严重程度的早期实验室生物标志物：系统评价和荟萃分析。

Early laboratory biomarkers for severity in acute pancreatitis; A systematic review and meta-analysis.

机构信息

Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, the Netherlands.

出版信息

Pancreatology. 2020 Oct;20(7):1302-1311. doi: 10.1016/j.pan.2020.09.007. Epub 2020 Sep 8.

DOI:10.1016/j.pan.2020.09.007

PMID:32938552

Abstract

BACKGROUND/OBJECTIVES: Acute pancreatitis is complicated by local and systemic complications in 20-30% of the patients. Accurate prediction of severity may be important for clinical decision making. Our aim is to identify and compare the accuracy of laboratory biomarkers that predict severity and complications in adult patients.

METHODS

Medline, EMBASE, Web of Science and Cochrane Library (1993 to August 2020) were searched for studies with an unselected population of patients with acute pancreatitis, that contains accuracy data for ≥1 laboratory biomarker(s) and/or APACHE-II score for the prediction of a patient outcomes of interest during the first 48 h of admission. The primary outcome is moderate severe or severe acute pancreatitis (MSAP/SAP). Secondary outcomes are severe acute pancreatitis, pancreatic necrosis and organ failure. Risk of bias was assed using QUADAS-2. Biomarkers extracted from ≥3 unique sources, were analyzed using hierarchical summary receiver operating characteristic (HSROC) and bivariate model analysis.

RESULTS

In total, 181 studies were included in the qualitative analysis reporting on 29 biomarkers. For the primary outcome at admission, summary sensitivities and specificities were, respectively, 87% (95% CI 69-95%) and 88% (95% CI 80-93%) for IL-6 at a threshold of >50 pg/ml, 72% (95% CI 64-79%) and 76% (95% CI 67-84%) for an APACHE-II score of ≥8, and 53% (95% CI 35-71%) and 82% (95% CI 74-88%) for CRP >150 mg/l. HSROC curve analysis confirmed these results.

CONCLUSION

This study indicates superiority of IL-6 for the early prediction of MSAP/SAP and may be used for to guide clinical decision making.

摘要

背景/目的：20-30%的急性胰腺炎患者会出现局部和全身并发症。准确预测严重程度对于临床决策可能很重要。我们的目的是确定并比较预测成人患者严重程度和并发症的实验室生物标志物的准确性。

方法

检索 Medline、EMBASE、Web of Science 和 Cochrane Library（1993 年至 2020 年 8 月），以查找包含≥1 种实验室生物标志物和/或 APACHE-II 评分数据的急性胰腺炎未选择人群的研究，这些数据可用于预测入院后 48 小时内患者的预后。主要结局为中度重症或重症急性胰腺炎（MSAP/SAP）。次要结局为重症急性胰腺炎、胰腺坏死和器官衰竭。使用 QUADAS-2 评估偏倚风险。从≥3 个独特来源提取的生物标志物使用分层汇总受试者工作特征（HSROC）和双变量模型分析进行分析。

结果

共有 181 项研究纳入了定性分析，报告了 29 种生物标志物。对于入院时的主要结局，IL-6 阈值>50pg/ml 时的汇总敏感度和特异性分别为 87%（95%CI 69-95%）和 88%（95%CI 80-93%），APACHE-II 评分≥8 时的分别为 72%（95%CI 64-79%）和 76%（95%CI 67-84%），CRP>150mg/l 时的分别为 53%（95%CI 35-71%）和 82%（95%CI 74-88%）。HSROC 曲线分析证实了这些结果。