Han Tianyong, Cheng Tao, Liao Ye, Lai Qiang, Tang Shiyuan, Liu Bofu, He Yarong, Lei Chenxi, Cao Yuling, Cao Yu
Emergency Department, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.
Medical Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, Sichuan, People's Republic of China.
J Inflamm Res. 2022 Jun 4;15:3323-3335. doi: 10.2147/JIR.S366246. eCollection 2022.
The thrombo-inflammatory prognostic score (TIPS) and the bedside index for severity in acute pancreatitis (BISAP) are both scoring systems that enable the rapid prognostic assessment of early-stage acute pancreatitis (AP) patients, but the overall prognostic utility of these individual systems is limited. This study was thus developed to explore whether a combination of TIPS and BISAP scores would offer better insight to facilitate the risk stratification of AP patients.
This single-center retrospective cohort research evaluated AP cases referred to the emergency department from January 1, 2017 to September 30, 2017. The ability of TIPS scores to improve BISAP-based AP patient risk stratification was appraised employing the curves of receiver-operating characteristic (ROC) and decision curve analysis (DCA) approaches. The initial endpoint for this research was 28-day mortality, while secondary endpoints comprised intensive care unit admission (AICU) and mechanical ventilation (MV) over a 28-day follow-up period.
Totally, 440 cases enrolled in the current study were divided at a ratio of 1:1 to derivation and validation cohorts. When estimating 28-day mortality, the combination of TIPS and BISAP (T-BISAP) improved the area under the curve (AUC) value in the derivation group from 0.809 to 0.903 (P < 0.05), in addition to similarly improving this AUC value from 0.709 to 0.853 (P < 0.05) in the validation cohort. Moreover, T-BISAP significantly improved the AUC values for 28-day AICU from 0.751 to 0.824 (P < 0.05) and the AUC values for 28-day MV from 0.755 to 0.808 (P < 0.05). A DCA approach revealed T-BISAP to exhibit higher net benefit when used for patient risk stratification as compared to BISAP alone.
The addition of TIPS scores to BISAP scores can enable prediction of 28-day adverse clinical outcomes with AP patients in the ED.
血栓炎症预后评分（TIPS）和急性胰腺炎严重程度床边指数（BISAP）都是能够对早期急性胰腺炎（AP）患者进行快速预后评估的评分系统，但这些单一系统的总体预后效用有限。因此，本研究旨在探讨TIPS和BISAP评分的组合是否能提供更好的见解，以促进AP患者的风险分层。
这项单中心回顾性队列研究评估了2017年1月1日至2017年9月30日转诊至急诊科的AP病例。采用受试者操作特征（ROC）曲线和决策曲线分析（DCA）方法评估TIPS评分改善基于BISAP的AP患者风险分层的能力。本研究的初始终点为28天死亡率，次要终点包括28天随访期内的重症监护病房入住（AICU）和机械通气（MV）。
本研究共纳入440例患者，按1:1的比例分为推导队列和验证队列。在估计28天死亡率时，TIPS和BISAP的组合（T-BISAP）使推导组的曲线下面积（AUC）值从0.809提高到0.903（P<0.05），在验证队列中，该AUC值也从0.709提高到0.853（P<0.05）。此外，T-BISAP显著提高了28天AICU的AUC值，从0.751提高到0.824（P<0.05），以及28天MV的AUC值，从0.755提高到0.808（P<0.05）。DCA方法显示，与单独使用BISAP相比，T-BISAP用于患者风险分层时具有更高的净效益。
在BISAP评分中加入TIPS评分可以预测急诊科AP患者28天的不良临床结局。
