Yin Xu, Zhong Xiang, Li Jun, Le Ma, Shan Shiting, Zhu Chunfu
Department of Hepatobiliary and Pancreatic Surgery, Changzhou No.2 People's Hospital Affiliated with Nanjing Medical University, Changzhou, Jiangsu, 213000, People's Republic of China.
Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, 226000, People's Republic of China.
Int J Gen Med. 2022 May 17;15:5015-5025. doi: 10.2147/IJGM.S356626. eCollection 2022.
To explore the value of modified RANSON score in predicting mortality from severe acute pancreatitis (SAP).
In this retrospective study, 461 SAP patients hospitalized from January 2016 to January 2020 were enrolled. AP (acute pancreatitis) patients from our hospital were employed as the training set. In addition, AP patients from the affiliated hospital of Nantong University were set as the validation set. The clinical characteristics of patients were compared between the two sets. The independent risk factors for SAP were determined through logistic regression. Moreover, the risk factors were derived for various prediction models by logistic regression. Multiple methods were adopted to assess the predictive ability of various models.
A total of 338 patients were assigned into the training set, while 123 patients were assigned into the validation set. The patients in the training and validation sets showed the consistent distribution trends (P>0.05). In the training set, significant differences between patients in the non-survival and survival groups were BMI, PCT, platelets (PLT), direct bilirubin (DBil) and RANSON scores (P<0.05). In further multivariate analysis, BMI, PCT and RANSON score were found as the independent risk factors for the mortality of SAP (OR=1.12, 1.25, 1.28, 95% CI:1.06-1.19, 1.08-1.44, 1.12-1.47, P<0.05). In the training set and validation set, ROC curve analysis showed that AUC of BMI+RANSON score was 0.778 and 0.789, respectively. In the calibration curve, the fitting degree of RANSON score+BMI and ideal assessment model was 0.975 and 0.854, respectively. The decision curve suggested that the net benefit per patient increased with the lengthening of the RANSON score+ BMI model curve. As revealed by the results of NRI and IDI indicators, RANSON score+BMI was optimized based on RANSON score (P<0.05).
BMI+RANSON was confirmed as a modified model effective in predicting the mortality from SAP.
探讨改良Ranson评分在预测重症急性胰腺炎（SAP）死亡率中的价值。
在这项回顾性研究中，纳入了2016年1月至2020年1月期间住院的461例SAP患者。将我院的急性胰腺炎（AP）患者作为训练集。此外，将南通大学附属医院的AP患者作为验证集。比较两组患者的临床特征。通过逻辑回归确定SAP的独立危险因素。此外，通过逻辑回归得出各种预测模型的危险因素。采用多种方法评估各种模型的预测能力。
共338例患者被纳入训练集，123例患者被纳入验证集。训练集和验证集患者的分布趋势一致（P>0.05）。在训练集中，非生存组和生存组患者的BMI、降钙素原（PCT）、血小板（PLT）、直接胆红素（DBil）和Ranson评分存在显著差异（P<0.05）。进一步的多因素分析发现，BMI、PCT和Ranson评分是SAP死亡率的独立危险因素（OR=1.12、1.25、1.28，95%CI：1.06-1.19、1.08-1.44、1.12-1.47，P<0.05）。在训练集和验证集中，ROC曲线分析显示BMI+Ranson评分的AUC分别为0.778和0.789。在校准曲线中，Ranson评分+BMI与理想评估模型的拟合度分别为0.975和0.854。决策曲线表明，随着Ranson评分+BMI模型曲线的延长，每位患者的净效益增加。NRI和IDI指标结果显示，Ranson评分+BMI在Ranson评分的基础上得到了优化（P<0.05）。
BMI+Ranson被确认为一种有效预测SAP死亡率的改良模型。
