Lv Yong-Cai, Yao Yan-Hua, Zhang Juan, Wang Yu-Jie, Lei Jing-Jing
Department of Gastroenterology, Zhenning Buyi and Miao Autonomous County People's Hospital, Zhenning 561200, Guizhou Province, China.
Department of Gastroenterology, The Affiliated Baiyun Hospital of Guizhou Medical University, Guiyang 550014, Guizhou Province, China.
World J Exp Med. 2023 Dec 20;13(5):115-122. doi: 10.5493/wjem.v13.i5.115.
Compared with patients with other causes of acute pancreatitis, those with hypertriglyceridemia-induced acute pancreatitis (HTG-AP) are more likely to develop persistent organ failure (POF). Therefore, recognizing the individuals at risk of developing POF early in the HTG-AP process is a vital for improving outcomes. Bedside index for severity in acute pancreatitis (BISAP), a simple parameter that is obtained 24 h after admission, is an ideal index to predict HTG-AP severity; however, the suboptimal sensitivity limits its clinical application. Hence, current clinical scoring systems and biochemical parameters are not sufficient for predicting HTG-AP severity.
To elucidate the early predictive value of red cell distribution width (RDW) for POF in HTG-AP.
In total, 102 patients with HTG-AP were retrospectively enrolled. Demographic and clinical data, including RDW, were collected from all patients on admission.
Based on the Revised Atlanta Classification, 37 (33%) of 102 patients with HTG-AP were diagnosed with POF. On admission, RDW was significantly higher in patients with HTG-AP and POF than in those without POF (14.4% 12.5%, < 0.001). The receiver operating characteristic curve demonstrated a good discriminative power of RDW for POF with a cutoff of 13.1%, where the area under the curve (AUC), sensitivity, and specificity were 0.85, 82.4%, and 77.9%, respectively. When the RDW was ≥ 13.1% and one point was added to the original BISAP to obtain a new BISAP score, we achieved a higher AUC, sensitivity, and specificity of 0.89, 91.2%, and 67.6%, respectively.
RDW is a promising predictor of POF in patients with HTG-AP, and the addition of RDW can promote the sensitivity of BISAP.
与其他病因所致急性胰腺炎患者相比，高甘油三酯血症性急性胰腺炎（HTG-AP）患者更易发生持续性器官功能衰竭（POF）。因此，在HTG-AP病程早期识别有发生POF风险的个体对改善预后至关重要。急性胰腺炎床边严重程度指数（BISAP）是入院24小时后获取的一个简单参数，是预测HTG-AP严重程度的理想指标；然而，其欠佳的敏感性限制了其临床应用。因此，目前的临床评分系统和生化参数不足以预测HTG-AP的严重程度。
阐明红细胞分布宽度（RDW）对HTG-AP患者POF的早期预测价值。
共回顾性纳入102例HTG-AP患者。收集所有患者入院时的人口统计学和临床资料，包括RDW。
根据修订的亚特兰大分类标准，102例HTG-AP患者中有37例（33%）被诊断为POF。入院时，HTG-AP合并POF患者的RDW显著高于未合并POF患者（14.4%对12.5%，P<0.001）。受试者工作特征曲线显示，RDW对POF具有良好的判别能力，截断值为13.1%，曲线下面积（AUC）、敏感性和特异性分别为0.85、82.4%和77.9%。当RDW≥13.1%且在原BISAP基础上加1分时获得新的BISAP评分，此时AUC、敏感性和特异性更高，分别为0.89、91.2%和67.6%。
RDW是HTG-AP患者POF的一个有前景的预测指标，加入RDW可提高BISAP的敏感性。
