Librero-Jiménez Marta, Valverde-López Francisco, Abellán-Alfocea Patricia, Fernández-Cano María Carmen, Fernández-Fernández Eleazar, Martínez-Cara Juan Gabriel, López-González Elisabet, Jiménez-Rosales Rita, Redondo-Cerezo Eduardo
Department of Gastroenterology and Hepatology, University Hospital Virgen de las Nieves, 18014 Granada, Spain.
J Clin Med. 2024 Jul 28;13(15):4412. doi: 10.3390/jcm13154412.
Early identification of patients at risk of developing severe acute pancreatitis (SAP) is still an issue. Dynamic assessment of clinical and laboratory parameters within the first 48 h of admission may offer valuable insights into the prediction of unfavorable outcomes such as SAP and death. A prospective observational study was conducted on a cohort of patients admitted for AP at a tertiary referral hospital. Clinical and laboratory data were collected on admission and at 48 h. Patients were classified based on the Revised Atlanta classification. Logistic regression analysis was performed to identify independent risk factors for SAP. Likelihood ratios and post-test probabilities were calculated to assess the clinical usefulness of predictive markers. 227 patients were included, with biliary etiology being the most common and a prevalence of SAP and death of 10.7% and 5.7%, respectively. BISAP ≥ 2 on admission, presence of SIRS after 48 h, rise in heart rate over 20 bpm, and any increase in BUN after 48 h were independent risk factors for SAP. The combination of these factors increased the post-test probability of SAP and death, with BISAP ≥ 2 combined with the presence of SIRS after 48 h showing the highest probability (82% and 73%, respectively). Dynamic assessment of BUN, heart rate, and SIRS within the first 48 h of admission can aid in predicting the development of SAP and death in patients with AP. These findings underscore the importance of continuous monitoring, although multicenter studies are warranted to refine predictive models for SAP.
早期识别有发生重症急性胰腺炎（SAP）风险的患者仍是一个问题。入院后48小时内对临床和实验室参数进行动态评估，可能为预测诸如SAP和死亡等不良结局提供有价值的见解。对一家三级转诊医院收治的急性胰腺炎（AP）患者队列进行了一项前瞻性观察研究。在入院时和48小时时收集临床和实验室数据。根据修订的亚特兰大分类对患者进行分类。进行逻辑回归分析以确定SAP的独立危险因素。计算似然比和检验后概率以评估预测标志物的临床实用性。纳入了227例患者，胆源性病因最为常见，SAP和死亡的发生率分别为10.7%和5.7%。入院时BISAP≥2、48小时后出现全身炎症反应综合征（SIRS）、心率升高超过20次/分以及48小时后血尿素氮（BUN）有任何升高是SAP的独立危险因素。这些因素的组合增加了SAP和死亡的检验后概率，其中BISAP≥2与48小时后出现SIRS相结合时概率最高（分别为82%和73%）。入院后48小时内对BUN、心率和SIRS进行动态评估有助于预测AP患者发生SAP和死亡的情况。这些发现强调了持续监测的重要性，尽管需要多中心研究来完善SAP的预测模型。
