Lin Long, Yang Kai-Hua, Chen Chang-Cheng, Shen Shu-Hong, Hu Wen-Ting, Deng Zhao-Hui
Department of Gastroenterology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, China.
Department of Hematology/Oncology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No. 1678 Dongfang Road, Shanghai, China.
Ann Hematol. 2025 Feb;104(2):1015-1022. doi: 10.1007/s00277-024-06133-9. Epub 2024 Dec 16.
We aimed to investigate whether early clinical indicators were associated with eventual disease severity, and to develop a predictive model for severe asparaginase-associated pancreatitis (AAP). Seventy-five acute lymphoblastic leukaemia (ALL) cases with AAP admitted to Shanghai Children's Medical Center from March 2013 to August 2023 were divided into non-severe (n = 44) and severe (n = 31) groups based on Atlanta diagnostic and AAP grading criteria. We compared essential information, asparaginase(ASP) dosage form, cumulative dose, clinical characteristics and laboratory tests between the groups. Statistically significant indicators were analysed with multifactorial logistic regression to identify independent risk factors for severe AAP. Receiver operating characteristic (ROC) curves assessed the early predictive value of age, C-reactive protein (CRP) and fibrinogen (FIB) levels. In the early stages of AAP onset, significant differences in age, CRP, platelet count, red blood cell distribution width, albumin, calcium, FIB, and D-dimer levels were found between the non-severe and severe AAP groups (p < 0.05). Multifactorial logistic regression identified age (odds ratio [OR] = 1.204, p = 0.035), CRP (OR = 1.334, p = 0.003), and FIB (OR = 0.85, p = 0.008) as independent predictors of severe AAP. ROC analysis showed an area under the curves (AUC) for age was 0.681 (95% CI: 0.557-0.805), CRP was 0.766 (95% CI: 0.653-0.880), FIB was 0.735 (95% CI: 0.612-0.857). Optimal cut-off values for age, CRP, and FIB were 9.46 years, 48.5 mg/L and 1.265 g/L respectively. The combined AUC was 0.916 (95% CI: 0.845-0.986), with 0.903 sensitivity and 0.818 specificity, outperforming individual predictors (p < 0.05). Age, CRP, and FIB levels are good early predictors of severe AAP, and their combination significantly improves predictive accuracy.
我们旨在研究早期临床指标是否与最终疾病严重程度相关，并建立一种预测严重天冬酰胺酶相关性胰腺炎（AAP）的模型。2013年3月至2023年8月期间收治于上海儿童医学中心的75例患AAP的急性淋巴细胞白血病（ALL）病例，根据亚特兰大诊断标准和AAP分级标准分为非严重组（n = 44）和严重组（n = 31）。我们比较了两组之间的基本信息、天冬酰胺酶（ASP）剂型、累积剂量、临床特征和实验室检查结果。对具有统计学意义的指标进行多因素逻辑回归分析，以确定严重AAP的独立危险因素。通过受试者工作特征（ROC）曲线评估年龄、C反应蛋白（CRP）和纤维蛋白原（FIB）水平的早期预测价值。在AAP发病早期，非严重AAP组和严重AAP组在年龄、CRP、血小板计数、红细胞分布宽度、白蛋白、钙、FIB和D - 二聚体水平上存在显著差异（p < 0.05）。多因素逻辑回归分析确定年龄（比值比[OR] = 1.204，p = 0.035）、CRP（OR = 1.334，p = 0.003）和FIB（OR = 0.85，p = 0.008）为严重AAP的独立预测因素。ROC分析显示，年龄的曲线下面积（AUC）为0.681（95%置信区间：0.557 - 0.805），CRP为0.766（95%置信区间：0.653 - 0.880），FIB为0.735（95%置信区间：0.612 - 0.857）。年龄、CRP和FIB的最佳截断值分别为9.46岁、48.5 mg/L和1.265 g/L。联合AUC为0.916（95%置信区间：0.845 - 0.986），敏感性为0.903，特异性为0.818，优于单个预测因素（p < 0.05）。年龄、CRP和FIB水平是严重AAP良好的早期预测指标，它们的联合使用显著提高了预测准确性。
