在急诊科急性胰腺炎患者中，比较床边急性胰腺炎严重程度指数和急诊 SpO2、年龄和全身炎症反应综合征评分在预测重症急性胰腺炎中的作用。

Comparison of Bedside Index for Severity in Acute Pancreatitis and Emergency Department SpO, Age and Systemic Inflammatory Response Syndrome Scores in Predicting Severe Acute Pancreatitis in Patients with Acute Pancreatitis in the Emergency Department.

机构信息

Department of Emergency Medicine, Arnavutkoy State Hospital, Istanbul, Turkey.

Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Turkey.

出版信息

J Emerg Med. 2024 Jul;67(1):e10-e21. doi: 10.1016/j.jemermed.2024.03.014. Epub 2024 Mar 16.

DOI:10.1016/j.jemermed.2024.03.014

PMID:38806350

Abstract

BACKGROUND

As the mortality of severe acute pancreatitis (SAP) is significantly higher than those with mild or moderate severity, it is of clinical significance to identify patients most likely to develop SAP at the time of emergency department (ED) presentation.

OBJECTIVES

The aim of this study was to compare the performance of the Bedside Index for Severity in Acute Pancreatitis (BISAP) and the Emergency Department SpO, Age and SIRS (ED-SAS) scoring systems as early risk assessment tools for identifying patients at high-risk of developing SAP.

METHODS

We retrospectively reviewed adult patients with AP presented to ED between January 2019-September 2022. We calculated the scores of each patient with the parameters of the initial data. The primary outcome was SAP. The secondary outcomes were 30-day mortality, intensive care admission, and identifying low-risk patients without complications.

RESULTS

Of 415 patients, 34 (8.2%) developed SAP and 15 (3.6%) died. With regard to predicting SAP, BISAP and ED-SAS scores had similar discriminative ability with area under the curves (AUCs) of 0.84 (95% confidence interval [CI]:0.80-0.88) and 0.83 (95% CI:0.79-0.86), respectively (p = 0.642). At a cut-off score of ≥2 for SAP, sensitivity/specificity values were 73.5%/82.4% for BISAP, 76.5%/83.2% for ED-SAS. BISAP and ED-SAS scores of ≥3, yielded sensitivity/specificity values of 50%/95.8% and 35.3%/95.5%, respectively. BISAP and ED-SAS were also similar in predicting mortality (AUCs of 0.92 vs. 0.90, respectively) and intensive care unit admission (AUCs 0.91 vs. 0.91).

CONCLUSION

The BISAP and ED-SAS scores performed similarly in predicting SAP, mortality, and intensive care unit admission. As an easily calculated tool early in the ED, ED-SAS may be helpful in disposition decisions for emergency physicians.

摘要

背景

重症急性胰腺炎（SAP）的死亡率明显高于轻度或中度 SAP，因此在急诊科（ED）就诊时识别最有可能发展为 SAP 的患者具有重要的临床意义。

目的

本研究旨在比较床边严重程度指数急性胰腺炎（BISAP）和急诊 SpO2、年龄和 SIRS（ED-SAS）评分系统作为早期风险评估工具，以识别有发展为 SAP 高危风险的患者。

方法

我们回顾性分析了 2019 年 1 月至 2022 年 9 月期间在 ED 就诊的成年急性胰腺炎患者。我们计算了每位患者根据初始数据参数的评分。主要结局是 SAP。次要结局是 30 天死亡率、重症监护病房入院率和识别无并发症的低风险患者。

结果

在 415 名患者中，有 34 名（8.2%）发展为 SAP，有 15 名（3.6%）死亡。在预测 SAP 方面，BISAP 和 ED-SAS 评分的鉴别能力相似，曲线下面积（AUC）分别为 0.84（95%置信区间 [CI]：0.80-0.88）和 0.83（95% CI：0.79-0.86）（p=0.642）。对于 SAP 的截断值≥2，BISAP 的灵敏度/特异性值分别为 73.5%/82.4%，ED-SAS 分别为 76.5%/83.2%。BISAP 和 ED-SAS 评分≥3 时，灵敏度/特异性值分别为 50%/95.8%和 35.3%/95.5%。BISAP 和 ED-SAS 在预测死亡率（AUC 分别为 0.92 和 0.90）和重症监护病房入院率（AUC 分别为 0.91 和 0.91）方面也相似。