Department of Gastroenterology, Wenjiang District People's Hospital of Chengdu.
Department of Gastroenterology, Affiliated Hospital of Southwest Medical University.
J Clin Gastroenterol. 2024 Mar 1;58(3):307-314. doi: 10.1097/MCG.0000000000001843.
In this study, we conducted this network meta-analysis (based on the ANOVA model) to evaluate the predictive efficacy of each early predictor.
Persistent organ failure (POF) is one of the determining factors in patients with acute pancreatitis (AP); however, the diagnosis of POF has a long-time lag (>48 h). It is of great clinical significance for the early noninvasive prediction of POF.
We conducted a comprehensive and systematic search in PubMed, Cochrane library, Embase, and Web of Science to identify relevant clinical trials, case-control studies, or cohort studies, extracted the early indicators of POF in studies, and summarized the predictive efficacy of each indicator through network meta-analysis. The diagnostic odds ratio (DOR) was used to rank the prediction efficiency of each indicator.
We identified 23 studies in this network meta-analysis, including 10,393 patients with AP, of which 2014 patients had POF. A total of 10 early prediction indicators were extracted. The mean and 95% CI lower limit of each predictive indicator were greater than 1.0. Albumin had the largest diagnostic odds ratio, followed by high-density lipoprotein-cholesterol (HDL-C), Ranson Score, beside index for severity in acute pancreatitis Score, acute physiology and chronic health evaluation II, C-reactive protein (CRP), Interleukin 6 (IL-6), Interleukin 8 (IL-8), Systemic Inflammatory Response Syndrome (SIRS) and blood urea nitrogen.
Albumin, high-density lipoprotein-cholesterol, Ranson Score, and beside index for severity in acute pancreatitis Score are effective in the early prediction of POF in patients with AP, which can provide evidence for developing effective prediction systems. However, due to the limitations of the extraction method of predictive indicators in this study, some effective indicators may not be included in this meta-analysis.
本研究采用基于方差分析模型的网状meta 分析，评价各早期预测因子的预测效能。
持续性器官衰竭（POF）是急性胰腺炎（AP）患者的决定因素之一；然而，POF 的诊断存在时间滞后（>48 h）。因此，对 POF 进行早期无创预测具有重要的临床意义。
我们在 PubMed、Cochrane 图书馆、Embase 和 Web of Science 中进行了全面系统的检索，以确定相关的临床试验、病例对照研究或队列研究，提取研究中 POF 的早期指标，并通过网状meta 分析总结各指标的预测效能。采用诊断优势比（DOR）对各指标的预测效率进行排序。
本网状meta 分析共纳入 23 项研究，包括 10393 例 AP 患者，其中 2014 例患者发生 POF。共提取 10 个早期预测指标。各预测指标的均值和 95%CI 下限均大于 1.0。白蛋白的诊断优势比最大，其次是高密度脂蛋白胆固醇（HDL-C）、Ranson 评分、急性胰腺炎严重程度床边指数、急性生理学和慢性健康状况评分Ⅱ、C 反应蛋白（CRP）、白细胞介素 6（IL-6）、白细胞介素 8（IL-8）、全身炎症反应综合征（SIRS）和血尿素氮。
白蛋白、高密度脂蛋白胆固醇、Ranson 评分和急性胰腺炎严重程度床边指数在预测 AP 患者 POF 方面具有较好的效果，可为开发有效的预测系统提供依据。但由于本研究中预测指标提取方法的局限性，可能会遗漏一些有效的指标。
