Ali Hassam, Bolick Nicole Leigh, Tillmann Hans
Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, North Carolina (Hassam Ali, Hans Tillmann).
Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida (Nicole Leigh Bolick), USA.
Ann Gastroenterol. 2022 Sep-Oct;35(5):551-556. doi: 10.20524/aog.2022.0729. Epub 2022 Jul 11.
Acute necrotizing pancreatitis (ANP) can result in a significant healthcare burden. The present study aimed to develop a new scoring system to accurately and promptly identify patients with a high likelihood of mortality to determine the need for aggressive measures.
We retrospectively analyzed patients diagnosed with ANP using the National Inpatient Sample (NIS). The mortality in ANP during admission (MANP-A) scoring system was derived using multivariate Cox regression analysis and validated using receiver operating characteristic (ROC) curves in a validation cohort.
A total of 22,980 hospitalizations were identified in the derivation cohort. There was a predominance of males (65%) and white race (73%). Five variables showed significant association with mortality and were selected for developing the MANP-A scoring system: age ≥60 years; acute renal failure/kidney injury; sepsis with shock; vasopressor use; and disseminated intravascular coagulation. The MANP-A score has a maximum of 5 points and the cutoff for predicting mortality was set at 2 points. The area under the curve (AUC) using the ROC curve of the derivation cohort was 0.9195, 95% confidence interval [CI] 0.8838-0.9551 (P<0.001) for 7- and 0.8954, 95%CI 0.8723-0.9185 (P<0.001) for 30-day periods. The AUC of the Validation Cohort was 0.9204, 95%CI 0.8937-0.9469 (P<0.001) for 7- and 0.9059, 95%CI 0.8893-0.9223 (P<0.001) for 30-day periods.
We propose a simple and objective score for predicting ANP inpatient mortality at 7- and 30-day intervals with high validity.
急性坏死性胰腺炎（ANP）会导致巨大的医疗负担。本研究旨在开发一种新的评分系统，以准确、及时地识别死亡可能性高的患者，从而确定采取积极措施的必要性。
我们使用国家住院样本（NIS）对诊断为ANP的患者进行回顾性分析。通过多变量Cox回归分析得出ANP住院期间死亡率（MANP-A）评分系统，并在验证队列中使用受试者工作特征（ROC）曲线进行验证。
在推导队列中总共确定了22980例住院病例。男性（65%）和白人（73%）占主导。五个变量与死亡率显示出显著关联，并被选入MANP-A评分系统的开发：年龄≥60岁；急性肾衰竭/肾损伤；伴有休克的脓毒症；使用血管升压药；以及弥散性血管内凝血。MANP-A评分最高为5分，预测死亡率的临界值设定为2分。推导队列ROC曲线在7天和30天的曲线下面积（AUC）分别为0.9195，95%置信区间[CI] 0.8838 - 0.9551（P<0.001）和0.8954，95%CI 0.8723 - 0.9185（P<0.001）。验证队列在7天和30天的AUC分别为0.9204，95%CI 0.8937 - 0.9469（P<0.001）和0.9059，95%CI 0.8893 - 0.9223（P<0.001）。
我们提出了一种简单、客观的评分系统，用于预测ANP患者7天和30天住院死亡率，具有较高的有效性。
